Journal Article

Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains

Bischof, Anja Yvonne, Kuklinski, David, Pross, Christoph, Geissler, Alexander, Steinbeck, Viktoria, Langenberger, Benedikt, Busse, Reinhard, Schöner, Lukas

2024

Overview

Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. Methods The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). Results Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. Conclusions Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. Trial registration German Register for Clinical Trials, DRKS00019916, 26 November 2019.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Arthritis / Arthroplasty / Arthroplasty (hip) / Arthroplasty (knee) / Bone surgery / Clinical outcomes / Clinical trials / Datasets / Demographic aspects / Depression, Mental / Equality and Human Rights / Fatigue / Female / Gender / Gender aspects / Gender differences / Gender health gap / Health aspects / Health care disparities / Health disparities / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Hip joint / Hospitals / Humans / Joint replacement / Joints (anatomy) / Knee / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Men / Mental depression / Orthopedics / Osteoarthritis / Pain / Patient outcomes / Patient Reported Outcome Measures / Patient-reported outcomes / Patients / Public Health / Quality of Life / Sex differences / Social Justice / Social Policy / Standard deviation / Surgery / Surveys and Questionnaires / Time measurement / Treatment Outcome / Variables / Women / Womens health