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The Impact of Social Determinants of Health Disparities on Thumb Carpometacarpal Joint Arthritis Treatment Patterns
Samara Kass, BS, BA
1, Samantha Maasarani, M.D., M.P.H.
2,3, Christopher Jou, MD
2,3, Daniel JP Bahat, MD
2,3, Nicholas Jarvis, MD
2,3, Adrienne Lee, MD
3; Kyle J Chepla, MD
3(1)Case Western Reserve University School of Medicine, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Metro Health Medical Center, Cleveland, OH
Hypothesis:We hypothesized that social determinants of health (SDOH) disparities influence clinical management of individuals with thumb carpometacarpal joint (CMC) arthritis.
Methods:A retrospective analysis was performed of all patients with thumb CMC arthritis evaluated by hand surgeons at our institution between 2000-2024. SDOH disparities were identified by the presence of any of the following: unemployment, Medicaid insurance, financial resource strain, intimate partner violence, housing stability risk, did not complete high school or GED equivalent, social connections risk, or transportation risk. Patients evaluated for CMC arthritis were then stratified into two cohorts, those with SDOH disparities (disparity cohort) and those without (non-disparity cohort).
Results:A total of 973 patients were included in our study with 416 in the disparity cohort and 557 in the non-disparity cohort. On average, patients were around 67 years old (SD 10.55), female (n=699, 71.8%), white (n=774, 79.6%), married (n=540, 55.5%), employed (n=378, 38.9%), Medicare insurance (n=482, 49.5%), and without history of tobacco use (n=428, 44.0%) (Table 1). There was no significant difference between cohorts for preoperative body mass index, hand dominance, affected thumb, average duration of splinting or number of steroid injections (Table 2/3).
The disparity cohort had significantly higher odds of being treated with splinting/topical analgesics (OR 1.73, 95% CI 1.28-2.32) and a significantly lower odds of undergoing surgical intervention (OR 0.7046, 95% CI 0.5242-0.9467) compared to the non-disparity cohort (Figure 1). Of those receiving surgery, there was no significant difference between cohorts for Eaton Littler classification, type of surgical intervention (arthroplasty, arthrodesis, denervation), postoperative complications, need for revision surgery, number of postoperative clinic visits attended, or number of occupational therapy visits attended (Table 3). Both the disparity and non-disparity cohorts had similar odds of being treated with steroid injections (OR 0.871, 95% CI 0.676 to 1.123).
Summary Points:Patients with CMC arthritis and social determinant of health disparities are more likely to be treated with conservative management including splinting and topical analgesics and are less likely to undergo surgical intervention. These disparities may represent barriers to care for these patients. Unfortunately, due to study methodology, we could not identify whether the disparities impacted recommended treatment by the treating surgeon or the influenced the patient's decision or ability to undergo and recover from surgery. While further study is required to determine how to address this disparity, this study has identified how social detriment of health disparities affects treatment of patients with CMC arthritis.
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