Abstract
The aim of the study was to assess racial disparities in utilization rates and outcomes after primary total elbow arthroplasty (TEA). We used the National Inpatient Sample from 1998 to 2010, a US national database. Patient characteristics, comorbidity and outcomes after TEA were assessed over time and differences by race studied over the study period. Cochran–Armitage test was used for time trends and logistic regression for the comparison of outcomes by race. In 1998, TEA utilization rate was 0.38/100,000 in Whites and 0.24/100,000 in Blacks (p = 0.002); in 2010, it was 0.91 and 0.59/100,000, respectively (p < 0.0001). White–Black disparity in TEA utilization was significant across 13 years (p = 0.03). Compared with White patients, Black patients undergoing TEA were younger (61.9 vs. 52 years; p < 0.0001), less likely to be female (70.6 vs. 61.4 %; p = 0.0007) and more likely to have rheumatoid arthritis as the underlying diagnosis (13.0 vs. 17.2 %; p = 0.036). Mortality was rare, 0.26 % in Blacks and 0.32 % in Whites (p = 0.83). Discharge to an inpatient facility was higher in White versus Black patients in unadjusted analyses (16.8 vs. 10.4 %; p = 0.003), but in analyses adjusted for age, sex, Deyo–Charlson index and the underlying diagnosis, the differences were no longer significant (p = 0.79). The length of hospital stay greater than the median stay was noted in 29.8 % Whites versus 31.2 % Blacks, respectively (p = 0.61). There was no evidence of White–Black disparity in hospital length of stay in 1998–2000 (p = 0.66) or 2009–2010 (p = 0.59) periods. In this study, we found persisting racial disparities in TEA utilization rates. No White–Black disparities were noted in TEA outcomes, except slight differences in discharge disposition.
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Acknowledgments
This material is the result of work supported by the resources and use of facilities at the Birmingham VA Medical Center, Alabama, USA. J.A.S. is also supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (CERTs), National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institute of Aging (NIA) and National Cancer Institute (NCI).
Conflict of interest
There are no financial conflicts related directly to this study. J.A.S. has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Allergan and Regeneron. R.R. has no conflicts.
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Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
The study was approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham, Birmingham.
The data are collected by the Mayo Clinic for clinical care of patients and maintained in an internal Mayo database that patients have provided permission to Mayo Clinic for analyses. We will make available these data to colleagues for any analyses, once appropriate approvals have been obtained from the IRBs and the data transfer is compliant with the HIPAA and appropriate permissions have been obtained from all involved parties.
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Singh, J.A., Ramachandran, R. Are there racial disparities in utilization and outcomes after total elbow arthroplasty?. Rheumatol Int 35, 1479–1487 (2015). https://doi.org/10.1007/s00296-015-3252-y
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DOI: https://doi.org/10.1007/s00296-015-3252-y