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Block Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010303","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Total knee arthroplasty (<jats:styled-content style=\"fixed-case\">TKA<\/jats:styled-content>) outcomes are worse for patients from poor neighborhoods, but whether education mitigates the effect of poverty is not known. We assessed the interaction between education and poverty on 2\u2010year Western Ontario and McMaster Universities Osteoarthritis Index (<jats:styled-content style=\"fixed-case\">WOMAC<\/jats:styled-content>) pain and function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patient\u2010level variables from an institutional registry were linked to <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> Census Bureau data (census tract [<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>] level). Statistical models including patient and <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\u2010level variables were constructed within multilevel frameworks. Linear mixed\u2010effects models with separate random intercepts for each <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> were used to assess the interaction between education and poverty at the individual and community level on <jats:styled-content style=\"fixed-case\">WOMAC<\/jats:styled-content> scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3,970 <jats:styled-content style=\"fixed-case\">TKA<\/jats:styled-content> patients, 2,438 (61%) had some college or more. Having no college was associated with worse pain and function at baseline and 2 years (<jats:italic>P<\/jats:italic> = 0.0001). Living in a poor neighborhood (&gt;20% below poverty line) was associated with worse 2\u2010year pain (<jats:italic>P<\/jats:italic> = 0.02) and function (<jats:italic>P<\/jats:italic> = 0.006). There was a strong interaction between individual education and community poverty with <jats:styled-content style=\"fixed-case\">WOMAC<\/jats:styled-content> scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college (83.4% versus 75.7%; <jats:italic>P<\/jats:italic> &lt; 0.0001); in wealthy communities, college was associated with a 1\u2010point difference in pain. Function was similar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In poor communities, those without college attain 2\u2010year <jats:styled-content style=\"fixed-case\">WOMAC<\/jats:styled-content> scores that are 10 points worse than those with some college; education has no impact on <jats:styled-content style=\"fixed-case\">TKA<\/jats:styled-content> outcomes in wealthy communities. How education protects those in impoverished communities warrants further study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23442","type":"journal-article","created":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T00:03:03Z","timestamp":1511308983000},"page":"884-891","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?"],"prefix":"10.1002","volume":"70","author":[{"given":"Susan M.","family":"Goodman","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery and Weill Cornell Medicine New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"Mandl","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery and Weill Cornell Medicine New York New 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