Racial Disparities in the Utilization of Shoulder Arthroplasty in the United States, Trends from 2011 to 2017
Kevin Xavier Farley, BS1, Jacob M Wilson, MD2, Alex Dawes, BS3, Roy Toston, BS4, John T Hurt, BS1, Michael Gottschalk, MD5 and Eric R. Wagner, MD1, (1)Emory University, Atlanta, GA, (2)Emory University, Department of Orthopaedics, Atlanta, GA, (3)Emory University School of Medicine, Atlanta, GA, (4)Emory University School Medicine, Atlanta, GA, (5)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA
INTRODUCTION: While incidence of shoulder arthroplasty continues to climb, racial disparities merit consideration, as they have been observed in lower extremity arthroplasty. Given the limited literature examining temporal trends in utilization and subsequent disparities in shoulder arthroplasty, we sought to examine these disparities.
METHODS: Using the National Inpatient Sample database, all anatomic total shoulder arthroplasties (aTSA) and reverse shoulder arthroplasties (RSA) were analyzed from 2011 to 2017. Patients were divided into Black, Hispanic, and white groups. Outcomes included incidence, length of stay, cost, and discharge destination. A multinomial logistic model was used for the statistical calculations.
RESULTS: 91.4% of patients undergoing shoulder arthroplasty were white, 4.75% were Black and 3.85% were Hispanic. Age and sex standardization utilization rates (per 100,000) of RSA increased 139%, from 6.94 in 2011 to 16.60 in 2017. Black patients increased from 3.18 to 7.41, while Hispanic patients increased from 3.7 to 8.17. Compared to white patients, this represented disparities of 118% and 112% in 2011 and 124% and 103% in 2017 for Black and Hispanic patients, respectively. In aTSA, when compared to white patients there were disparities of 150% and 169% in 2011 and 197% and 262% in 2017 for Black and Hispanic patients, respectively. The largest disparities were seen in Black males over 65 in both surgical techniques. Furthermore, the disparities in shoulder arthroplasty were greater than those in lower extremity arthroplasty. Finally, Blacks had comparatively increased non-home discharges (OR 1.32), LOS, and overall cost, while Hispanics had higher LOS and cost than whites.
CONCLUSION: Despite efforts to reduce racial disparities in healthcare, the apparent chasm in shoulder arthroplasty is widening, with disparities worse than those in lower extremity arthroplasty. Funding for research and education should be focused on this area to discover why these disparities exist and reduce barriers to accessing medical advances such as shoulder arthroplasty.
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