Examining Health Disparities in Orthopedic Care During COVID-19

Abstract

Background Demographics and socioeconomic status affect the delivery of medical care resulting in healthcare disparities. The purpose of this study was to investigate the impact of COVID-19 on existing healthcare disparities, including access to healthcare in the outpatient orthopedic surgery clinic. Methods The medical records of 3006 patients treated at the University of Kentucky Orthopedic Surgery Department prior to COVID-19 (April 2018, 2019), and during the COVID-19 pandemic (2020) were retrospectively reviewed for demographic data, distance to clinic, and type of visit. We then compared the total number of patient visits, new patient visits, telehealth visits, and the patient’s insurance provider (public or private) between the time period prior to and during the pandemic. Results During the COVID-19 pandemic, there were significant declines in the number of patients seen, new patient presentations, and publicly insured patients. Thirty-three percent of visits were telemedicine visits in 2020 compared to 0% pre-COVID ( P < .0001). There was a lower proportion of initial visits in 2020 ( P < .0001). The majority of patients paid via private/commercial insurance (1798, 59.8%), with a greater proportion paying via private/commercial insurance in 2020 ( P < .001). The median average household income was increased in 2020 ( P < .001). Discussion While COVID-19 resulted in a significant decline in overall access to care, there were negative ramifications particularly on patients with new complaints and those of lower socioeconomic status. Future endeavors should be focused on correcting the obstacles to accessing care, exacerbated by the pandemic, that these vulnerable populations face.

Socioeconomic disparities in lumbar fusion rates were exacerbated during the COVID-19 pandemic

“…A national study on 767 hospitals assessing all payer types found that White patients experienced the greatest reduction in elective surgeries, compared to other racial groups, suggesting that the pandemic did not exacerbate racial disparities in elective surgical care [6] . Further studies in bariatric, cardiac, and orthopedic surgical subspecialties revealed that patient populations were more diverse (lessened racial and SES disparities) after the onset of the pandemic for some surgical procedures but less diverse (greater racial and SES disparities) for others [7] , [8] , [9] , [10] . Studies assessing academic general surgery departments, however, showed that male, White, and privately insured patients were more likely to undergo medically-necessary procedures during the pandemic [11] and that patients with higher SES (commercial or non-governmental insurance) were more likely to utilize both in-person and telemedicine visits during the pandemic [12] .…”