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Underutilization of Hand Corticosteroid Injections and Arthroplasty for Minority Demographics in the United States
Christopher M Dussik, MD, Amy Phan, MD, Jeffrey Coombs, MD, Akhil Dondapati, MD, Andrew Jae-Min Park, MD, Danielle M Wilbur, MD, Ronald M Gonzalez, DO; Constantinos Ketonis, MD, PhD
University of Rochester Medical Center, Rochester, NY
Introduction: The management of hand osteoarthritis is a cornerstone of hand surgery practice. Corticosteroid injections and surgical interventions form mainstays of treatment for those patients with symptoms recalcitrant to less-invasive measures. Healthcare disparities have been increasingly recognized, particularly regarding variations in pain management. This study aimed to determine whether such disparities exist across different racial and ethnic groups in the treatment of hand osteoarthritis.
Materials and Methods: We utilized the TriNetX database to evaluate patients diagnosed with hand osteoarthritis between January 1, 2010 and December 31, 2024. Diagnostic and billing codes were used to identify patients, gauge healthcare exposure, and assess the use of corticosteroid injection and surgical intervention across different demographics. Outcomes were stratified based on racial and ethnic identification. Matching was performed to mitigate risk for confounding. Odds ratios were used to evaluate statistical significance.
Results: A total of 816,412 patients diagnosed with hand osteoarthritis were identified (Table 1). Non-Hispanic, white patients had nearly twice the odds of undergoing corticosteroid injections and demonstrated consistently higher rates of operative treatment compared to minority populations across unmatched analyses (Tables 2 and 3). After matching for demographic and comorbidity variables, these disparities largely persisted despite similar overall exposure to the healthcare system.
Conclusions: Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis. Similarly, these groups undergo operative management at considerably lower rates. These findings highlight the persistent disparities in treatment faced by underrepresented groups and underscore the critical importance of considering social determinants of health in the management of upper extremity conditions.
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