Racial and sex disparities in utilization rates for shoulder arthroplasty in the United States disparities in shoulder arthroplasty

Eichinger, Josef K.; Greenhouse, Alyssa; Rao, Meghana V.; Gordon, Eric; Brinton, Daniel; Li, Xinning; Curry, Emily J.; Friedman, Richard J.

doi:10.1016/j.jor.2019.02.029

Cited by 18 publications

(22 citation statements)

References 24 publications

(29 reference statements)

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“…Shoulder arthroplasty is a very well-recognized and effective treatment at reducing pain and re-establishing function for many common pathologies of the shoulder. 10,28 The reproducible success and expanded indications in the setting of an increasingly older population has led to predictable increases in utilization over the decade consistent with trends from older studies. [4][5][6]10,15,24 Our study demonstrated that TSA utilization doubled from 43 per 100 000 residents in 2009 to 73 per 100 000 residents in 2017.…”

Section: Discussionmentioning

confidence: 95%

“…10,28 The reproducible success and expanded indications in the setting of an increasingly older population has led to predictable increases in utilization over the decade consistent with trends from older studies. [4][5][6]10,15,24 Our study demonstrated that TSA utilization doubled from 43 per 100 000 residents in 2009 to 73 per 100 000 residents in 2017. Despite that dramatic increase, our study demonstrated that disparities previously seen in joint replacement procedures persisted with over two-thirds of that annual increase being accounted for by an increase in utilization by White residents while annual utilization by Black residents were largely unchanged.…”

Section: Discussionmentioning

confidence: 95%

“…8,10,13,15,29 Blum et al in a review of the literature showed that disparities in the utilization in joint replacement surgery exist due to many factors including insurance status, access to care, socioeconomic status, cultural differences, patient expectations, and preferences of joint arthroplasty surgery. 10,[30][31][32] Several studies have analyzed the role behavioral and social factors, such as patient preferences and expectations, play in influencing one's decision to seek medical care. 16 For example, compared with whites, blacks were more likely to rely on self-care measures such as prayer and were less likely to consider surgery for severe arthritis pain even when accounting for disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these differences in Hispanic utilization may be accounted for by regional differences as detailed by Einchinger et al who reported the disparity ratio for shoulder arthroplasty utilization was 0.16 in the Northeast compared to 0.33 in the West. 10 One specific issue more likely to affect our Hispanic patients is language concordance. While areas following continental migration such as the Southwest tend to have higher needs for interpreted services, greater than one in seven patients undergoing TKA in a single New York medical center required an interpreter for their visit.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Despite increasing utilization of total shoulder arthroplasty (TSA) as an effective management of various shoulder pathologies, [4][5][6] the literature has demonstrated that enduring racial and gender disparities exist in joint replacement procedures. [7][8][9][10][11][12][13][14][15] An 18-year analysis of Medicare part A data showed that in 1991, the use of primary total knee arthroplasty (TKA) was 36% lower for African-Americans compared with Caucasians. 1 Though utilization more than doubled for both African-Americans and Caucasians by 2008, the usage of primary TKA was still 40% lower for African-Americans.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Markes

Pareek

Mesfin

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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Introduction The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume. Methods We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance. Results Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers ( P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume. Conclusion Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

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