![]() We compared TKA use (age and gender, standardized per 10,000 population per year) for patients residing in the highest-income versus the lowest-income quintile neighborhoods. We linked patient-level data to the respective census data to determine community-level income using ZIP Code or postal code of residence and stratified patients into neighborhood income quintiles. We used data from the Pennsylvania Health Care Cost Containment Council, Harrisburg, PA, USA, and the ICES (formally the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada. We identified all patients hospitalized for primary TKA in this cross-border retrospective analysis, using administrative data for 2012 to 2018, and we found a total of 161,244 primary TKAs in Ontario and 208,016 TKAs in Pennsylvania. (1) Does TKA use differ between Pennsylvania, USA, and Ontario, Canada? (2) Are income-based disparities in TKA use larger in Pennsylvania or Ontario? (3) Are TKA outcomes (90-day mortality, 90-day readmission, and 1-year revision rates) different between Pennsylvania and Ontario? (4) Are income-based disparities in TKA outcomes larger in Pennsylvania or Ontario? Methods ![]() Although Canada’s single-payer healthcare system is assumed to attenuate the wealth-based differences in TKA use observed in the United States, empirical cross-border comparisons are lacking. Income-based differences in the use of and outcomes in TKA have been studied however, it is not known if different healthcare systems affect this relationship. This work was performed at the Hospital for Special Surgery New York, NY, USA, and ICES, which is an independent, nonprofit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement. One of the authors (BM) certifies receipt of personal payments or benefits, during the study period, in an amount of less than USD 10,000 from Novartis and Janssen.Īll ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.Įthical approval for this study was waived by Weill Cornell Medicine, New York, NY, USA (number 1808019505). One of the authors (PC) certifies receipt of personal payments or benefits, during the study period, in an amount of less than USD 10,000 in honoraria from the Centers for Medicare & Medicaid Services. One of the authors (MP) certifies receipt of personal payments or benefits, during the study period, in an amount of USD 10,000 to USD 100,000 for consulting fees from Zimmer Biomet. ![]() One of the authors (SG) certifies receipt of personal payments or benefits, during the study period, in an amount of less than USD 10,000 from consulting fees for Union Chimique Belge. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health. The institution of one author (PC) has received, during the study period, funding from a grant from the NIH (R01AG058878). The institution of one author (SG) has received, during the study period, funding from Novartis. The institution of one author (SI) has received, during the study period, funding from grant K24AR055259 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The institution of one author (BM) has received, during the study period, funding from the Kellen Scholar Award, which is supported by the Anna Marie and Stephen Kellen Foundation Total Knee Improvement Program. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources no endorsement is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health and the Canadian Institute for Health Information. ![]() Mehta ✉, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, Email: 1Department of Medicine, Hospital for Special Surgery, New York, NY, USAĢDivision of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USAĤSunnybrook Health Sciences Centre, Holland Centre, Toronto, Ontario, USAĥDepartment of Population Health Sciences, Weill Cornell Medicine, New York, NY, USAĦDepartment of Medicine, Weill Cornell Medicine, New York, NY, USAħDepartment of Medicine, University of Texas Medical Branch, Galveston, TX, USAī.
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