Association Between Social Deprivation and Longitudinal Research Productivity Among Orthopedic Surgery Residency Applicants

Objective Application to orthopedic surgery residency is increasingly competitive and the transition of USMLE Step 1 to pass/fail scoring has increased reliance on research productivity in applicant selection. However, access to research may be shaped by socioeconomic factors. This study evaluated the association between the Social Deprivation Index (SDI) and research productivity over a 15-year period spanning residency application through early-career practice. Design Retrospective cohort study. ERAS provided permanent ZIP codes and research metrics. Associations were assessed using Spearman's correlation, with statistical significance set at p < 0.05. Setting A single large academic U.S. orthopedic surgery residency program. Participants A total of 822 applicants during the 2010 application cycle. Thirty-nine applicants lacked assignable SDI scores, leaving 783 for application-stage analyses; 290 lacked Scopus profiles, leaving 493 for long-term analyses. Profile groups were compared. Results Higher SDI, indicating greater deprivation, was inversely correlated with number of research experiences (p = 0.002) and poster/oral presentations (p = 0.010); both persisted after correction for multiple comparisons (adjusted p = 0.012 and 0.030). SDI was not significantly associated with total application research items (p = 0.064), manuscripts (p = 0.078), or long-term outcomes, including post-ERAS publications (p = 0.472), total publications (p = 0.408), current citation count (p = 0.939), or h-index (p = 0.642). Excluded applicants reported less research at application but did not differ in SDI (p = 0.614). Conclusions Greater socioeconomic deprivation was associated with fewer research experiences and presentations on residency applications, suggesting reduced access to early research opportunities. These associations may be driven by differences in access to mentorship and financial flexibility to attend conferences, assume unpaid research, and complete research years. Socioeconomic disadvantage may be associated with reduced early academic engagement but was not associated with sustained publication output in this cohort.