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

Abstract

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.

Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures

“…While this is understandable given that these patients may require extended care in postacute care facilities depending on the severity of the adverse event, it is pertinent to stress that complications are potentially avoidable instances that can be controlled through adequate medical optimization, early mobilization, and close in-hospital observation, when needed, to allow patients to be discharged home safely and early. It is also important to mention that contrary to previous literature by Menendez and Ring, 23 we were unable to establish a racial disparity with regards to discharge destinations. It is possible that racial disparities may not exist at quality improvement hospitals.…”

“…Third, the NSQIP does not contain insurance-specific data that would have been beneficial for assessing given that previous literature has denoted significant insurance disparities present with regard to postacute care resource utilization. 23 The NSQIP also does not contain hospital-specific data, such as hospital size, location (rural/urban), and teaching status which would have been useful in adjusting for in our analysis. The database also lacks preadmission data, and therefore we were unable to account for those patients who may have previously failed nonoperative management of proximal humerus fractures.…”

The Association between Race and Extended Length of Stay in Low-energy Proximal Humerus Fractures in Elderly Patients

“…In a recent study of lower extremity orthopaedic injury evaluation in the US EDs, Gupta et al 14 found Black patients the least likely to be admitted as inpatient. Furthermore, our findings are consistent with those of Menendez et al 15 who reported that non-Hispanic Black patients admitted with PHFs experience increased LOS compared with their White counterparts (5.1 vs. 3.7 days) in an inpatient study. 15 Our results support a persisting disparity for Black orthopaedic patients.…”

“…Furthermore, our findings are consistent with those of Menendez et al 15 who reported that non-Hispanic Black patients admitted with PHFs experience increased LOS compared with their White counterparts (5.1 vs. 3.7 days) in an inpatient study. 15 Our results support a persisting disparity for Black orthopaedic patients. Importantly, increased LOS has been associated with worse patient outcomes and readmission in orthopaedics.…”

The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States

“… 2 , 19 , 23 In a study of over 40,000 patients admitted to US hospitals with a proximal humerus fracture, Hispanic and Black patients were more likely to be uninsured and less likely to use post-discharge support services than White patients. 18 Two national studies assessed racial disparities in hip fracture care and showed longer time to surgery and higher rates of complications in under-represented minority patients compared with White patients. 2 , 19 …”