Influence of Socioeconomic Deprivation on Healthcare Utilization After Shoulder Arthroplasty: A Systematic Review

Document Type

Conference Proceeding

Publication Date

5-9-2025

Abstract

Socioeconomic factors play a critical role in shaping healthcare outcomes, yet their impact on surgical recovery and postoperative quality of life is often underexplored. The Area Deprivation Index (ADI) is a validated metric used to quantify socioeconomic disadvantage, providing insight into disparities in healthcare access and outcomes. Despite its relevance, the extent of ADI score reporting in the context of total shoulder arthroplasty (TSA) remains unclear. This systematic review aims to assess the evidence surrounding ADI score utilization in TSA studies, focusing on its association with postoperative outcomes, complications, and quality of life measures.

The search was conducted using a PRISMA-compliant methodology across databases: Pubmed, Scopus, and Embase using the keywords "area deprivation index", "Shoulder arthroplasty", and "Outcomes" with all relevant MeSH configurations. This review includes studies that explicitly discuss or report the ADI, including ADI scores or related socioeconomic metrics in TSA populations. Eligible studies are those published in English within the past 10 years and reporting on postoperative outcomes, complications, and readmissions. Accepted study designs include randomized controlled trials and cohort studies. Studies were excluded if they did not involve TSA, lacked mention of ADI, or were case reports, reviews, editorials, or conference abstracts without original data. Non-English publications were also excluded.

This systematic review included 561 studies initially imported for screening with 224 duplicates removed. 336 titles and abstracts were screened, 23 full-text studies were assessed for eligibility, and 7 full-text articles were found relevant for this review. Higher deprivation correlated with worse PROMIS-UE and PROMIS-PI scores and higher rates of readmissions (OR = 1.77, P = .045) compared to less deprived groups. Patients with higher deprivation also showed worse postoperative patient-reported outcomes and higher complication rates, such as increased readmissions and emergency department (ED) visits. Follow-up adherence and hospital utilization were lower in more disadvantaged cohorts, despite no significant differences in total hospitalization costs being observed across ADI groups in some studies (P = .50).

Socioeconomic deprivation, as measured by the ADI, is associated with worse outcomes, higher readmission rates, and increased healthcare utilization following TSA. These findings highlight the importance of incorporating socioeconomic metrics like ADI into preoperative risk assessments to better identify at-risk populations.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025.
Abstract 1851

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