Influence of Immigrant Background onthe Outcome of Total Hip ArthroplastyBetter outcome in 280 Native Patients in Bosnia and Herzegovinian than in 449 Immigrants Living in Sweden

Background: Despite the overall success of THA, betwen 5-20% report unsatisfactory results. Several factors may cause this variable outcome. One of them is ethnicity, which because of its potential social impact on living conditions may influence life quality. We investigated whether patients born and operated in their home country Bosnia and Herzegovina, report the same results as do patients living in Sweden, born in Europe outside the Nordic countries.Methods: Data were prospectively collected from 280 patients planned to be operated with a THA in Bosnia and Herzegovina, and 449 immigrants born in Europe but outside the Nordic countries. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, pain, VAS, and satisfaction VAS. Data collected before the operation and 1 year after were studied. Results: Before the operation patients born and living in Bosnia and Herzegovina reported more problems with self-care and usual activities before and after adjustment for confounding. Patients living in Sweden reported higher EQ-VAS and more pain on VAS than did those born in Bosnia and Herzegovina, but the difference in EQ-VAS became statistically insignificant after adjustment for confounding. A higher share of patients living in Bosnia and Herzegovina reported more benefit 1 year after the operation in all dimension except from self-care as reflected in the basic chi-square test and the unadjusted and adjusted regression analyses. After adjustment for confounding this group of patients was also more satisfied, but there was no statistically significant difference in pain VAS and EQ-VAS when compared to the immigrant group living in Sweden. Conclusion: Our findings that immigrant patients operated in Sweden despite a tendency to more symptoms before the operation have less benefit from a THA according to EQ5D 1 year after the operation cause concern. We do not know to what extent this situation can be improved by a more multidimensional caretaking of immigrant patients. Probably other factors not only involving the healthcare system play a role as do probably also methodological problems related to these types of studies.