Arthritis: Poverty Worsens Preoperative Pain, Opioid Use

Socioeconomic status is known to affect patient-reported outcome scores and complication rates, however, there are still a lot of unknowns when it comes to its impact on shoulder arthroplasty.

A new study, “Lower Socioeconomic Status Is Associated With Worse Preoperative Function, Pain, and Increased Opioid Use in Patients With Primary Glenohumeral Osteoarthritis,” recently published in the Journal of the American Academy of Orthopaedic Surgeons explored this association in patients with primary glenohumeral osteoarthritis (OA).

According to The Steadman Clinic, “damage to the cartilage surfaces of the glenohumeral joint (the shoulder’s ‘ball-and-socket’ structure) is the primary cause of shoulder arthritis.”

Patients were assigned to a quartile according to the Area Deprivation Index using their home address as a measure of socioeconomic status.

Overall, the researchers found that lower socioeconomic status (SES) is associated with worse preoperative function, pain, and increased opioid use.

They analyzed data on 982 patients from a prospective shoulder arthroplasty registry. Besides patient demographics, they looked at comorbidities, patient reported outcome scores, range of motion, and preoperative opioid use.

According to the results, patients with lower socioeconomic status, had higher body mass index (BMI) and higher rates of preoperative opioid use and diabetes. They also reported more preoperative pain and lower function.

After multivariate regression, male patients and advanced age at surgery were associated with better American Shoulder and Elbow Surgeon (ASES) scores while preoperative opioid use, chronic back pain, and the most disadvantaged quartile were associated with worse ASES pain score.

The researchers wrote, “Lower SES correlates with worse preoperative function and pain in patients undergoing anatomic TSA [total shoulder arthroplasty] for primary glenohumeral OA. Providers should be cognizant of the potential impact of SES when evaluating quality metrics for patients with primary glenohumeral OA.”