Do insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients

Vegini, Julyan Baum; Steglich, Valdir; Ferreira, Ana Paula Bonilauri; Gandhi, Mihir; Shah, Jatin; Pietrobon, Ricardo

doi:10.1016/j.jse.2011.02.007

Cited by 9 publications

(11 citation statements)

References 25 publications

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“…Our observation is that few differences in TSA existed across SEP. Our findings of relative equity in TSA are similar to those of a US study that examined 3,529 TSA and which showed that insurance status (as a proxy for SEP) was not associated with uptake of TSA [ 40 ]. However, the lack of SEP variations in TSA are in contrast to the social gradient of arthritis in Australia, and also to the social gradient previously reported for the uptake of total knee arthroplasty across Australia [ 24 ].…”

Section: Discussionsupporting

confidence: 85%

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data

Brennan-Olsen

Page

Lane

et al. 2016

BMC Musculoskelet Disord

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BackgroundAssociations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007–11 for all Australians aged ≥40 years.MethodsPrimary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling.ResultsDuring 2007–11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales.ConclusionsUsing a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.

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Section: Discussionsupporting

confidence: 85%

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data

Brennan-Olsen

Page

Lane

et al. 2016

BMC Musculoskelet Disord

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“…This distribution in payor status among race groups is similar to other published numbers surrounding TSA and race on a nationwide basis. 33 Throughout the study time period, the TSA utilization of blacks favored a younger demographic than whites. This trend potentially could explain the observation that there was a less than expected number of blacks enrolled in Medicare.…”

Section: Discussionmentioning

confidence: 94%

Impact of Race and Gender on Utilization Rate of Total Shoulder Arthroplasty

Yu¹,

Mahure²,

Branch³

et al. 2016

Orthopedics

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Marked underutilization rates of total joint arthroplasty in minorities compared with nonminorities exist, with a paucity of literature surrounding inequities related to total shoulder arthroplasty (TSA). Using the Statewide Planning and Research Cooperative System database, patients who underwent elective TSA in New York State (NYS) were identified and characterized by age, race, gender, medical comorbidities, and payor status. Patients were stratified into 4 separate 5-year periods from 1990 to 2009. Comorbidity severity was defined using the Elixhauser criteria. A total of 10,538 elective TSAs were identified, with half of the procedures occurring in the most recent time quartile. Whites accounted for 70% of the procedures, whereas blacks accounted for 5%. During the 20-year period, the age-adjusted incidence of TSA in white men and women increased by 417% and 421%, respectively, whereas the incidence for black men and women increased by 378% and 329%, respectively. Black men had the lowest utilization rate among all subgroups, and overall disparity between races continued to widen over time. Blacks had significantly more comorbid conditions (P<.001) than whites when undergoing TSA. Blacks were more likely to have Medicaid insurance and less participation in Medicare (P<.001). Racial and gender disparities clearly exist in TSA utilization rates in NYS and may be worsening. Although reasons for these disparities are likely multifactorial, a deeper understanding of the factors involved in patient selection and access to care is necessary to appropriately address these disparities and effect change at a system-wide patient and provider level. [Orthopedics. 2016; 39(3):e538-e544.].

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“…12,13 The HCUP-NIS is the largest publicly available all-payer inpatient discharge database in the USA.…”

Section: Methodsmentioning

confidence: 99%

“…We performed a retrospective cross-sectional analysis of 2008 to 2011 discharge information obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database, an initiative first sponsored by the Agency for Healthcare Research and Quality in 1988. 12,13 The HCUP-NIS is the largest publicly available all-payer inpatient discharge database in the USA. 14 Each dataset year contains records on approximately 8 million discharges from over 1000 nonfederal hospitals, reflecting a 20% stratified sample of all discharges from randomly selected institutions in participating states.…”

Section: Methodsmentioning

confidence: 99%

Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture

Menendez

Ring

2014

Shoulder & Elbow

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Background: Post-discharge supportive services such as home health assistance and rehabilitation or skilled nursing facilities are often utilized after inpatient care for fracture of the proximal humerus. It is unclear whether sociodemographic disparities exist in the utilization of post-hospital supportive care. The present study aimed to evaluate the individual and combined effects of race and insurance status on the utilization of supportive services after hospital admission for fracture of the proximal humerus. Methods: Among the more than 40,000 patients with a proximal humerus fracture identified in the Nationwide Inpatient Sample (2008 to 2011), 85% were white, 7.7% were Hispanic and 7.0% were black. More black patients (19%) and Hispanic patients (15%) were uninsured compared to white patients (8.7%). Multivariable logistic regression was performed to determine the effect of race/ethnicity and insurance status on the utilization of post-hospital supportive care. Results: Sixty-nine percent of patients were discharged home, 13% went to home health care and 15% went to rehabilitation or skilled nursing facilities. Compared to white patients, Hispanic patients [odds ratio (OR) ¼ 0.71; 95% confidence interval (CI) ¼ 0.64 to 0.79] and black patients (OR ¼ 0.79; 95% CI ¼ 0.71 to 0.88) exhibited lower odds for the utilization of specialized post-hospital supportive services. Uninsured patients were significantly less likely to use post-discharge supportive services (OR ¼ 0.38; 95% CI ¼ 0.33 to 0.42) compared to privately insured patients. Even when insured at levels comparable to whites, Hispanic and black patients tended to experience decreased rates of discharge to post-acute supportive care. Conclusions: The utilization of post-hospital supportive services varies by race, ethnicity and insurance status after an inpatient admission for proximal humerus fracture.

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Do insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients

Cited by 9 publications

References 25 publications

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data

Impact of Race and Gender on Utilization Rate of Total Shoulder Arthroplasty

Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture

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