Patients of Lower Socioeconomic Status Initially Present to Clinic with Carpal Tunnel Syndrome with Worse Self-Reported Function and Pain
David N. Bernstein, MBA, MA1, Etka Kurucan, BA1, Kathleen Fear, PhD1, Bilal Mahmood, MD1, Constantinos Ketonis, MD, PhD1 and Warren C Hammert, M.D.2, (1)University of Rochester Medical Center, Rochester, NY, (2)Department of Orthopaedics, University of Rochester, Rochester, NY
Introduction: Socioeconomic status (SES) can have a notable impact on patient care, including quality and access. However, there is limited research on the impact of SES on presenting symptoms measured using validated patient-reported outcome measures (PROMs) for common hand conditions (e.g., carpal tunnel syndrome [CTS]). Our primary null hypothesis is there is no association between a patient's SES and the level of self-reported symptom severity, as measured by PROMIS Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression, at new patient visits for CTS.
Materials & Methods: Patients presenting to a tertiary academic hand clinic between 12/2016 and 12/2018 for a new patient visit for CTS completed PROMIS UE, PF, PI and Depression CATs. SES status was determined using the Area Deprivation Index (ADI), a validated measurement determined by zip code. ADIs were determined at both the state (0-10, 10 = lowest SES status) and national (0-100, 100 = lowest SES status) levels. Patient characteristics were reported. Multivariable linear regression was used to determine associations between social deprivation and presenting patient-reported health status at both the state and national levels.
Results: 400 patients met our inclusion criteria; a majority were white (88%) and female (62%). The average age was 56 years (range, 19 - 92). The average state and national ADI was 7 (range, 3-10) and 53 (range, 9 - 100), respectively. The average PROMIS UE, PF, PI and Depression scores were 40.22 (SD, 9.86), 44.97 (SD, 8.96), 57.38 (SD, 7.74), and 48.64 (SD, 9.52), respectively. In multivariable regression on the national level, ADI values were associated with PROMIS UE (β = -0.06, p<0.01) and PROMIS PI (β = 0.05, p<0.01) but not PROMIS PF or PROMIS Depression (Table 1). In multivariable regression on the state level, ADI values were associated with PROMIS UE (β = -0.79, p=0.03) and PROMIS PI (β = 0.58, p<0.05) but not PROMIS PF or PROMIS Depression (Table 2).
Conclusions: Lower SES is associated with worse upper extremity function, as measured by PROMIS UE, and higher levels of pain impacting daily function, as measured by PROMIS PI, on both the state and national levels when initially seeking care for CTS. Overall, patients of lower SES seek care for CTS when their symptoms are more severe at both the state and national levels, suggesting that healthcare access may not be equitable and/or patients of lower SES status have better coping mechanisms and present later.
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