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Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes

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Abstract

Objective

The purpose was to study whether racial disparities in total shoulder arthroplasty (TSA) utilization and outcomes have declined over time.

Methods

We used the US Nationwide Inpatient Sample from 1998 to 2011. We used chi-squared test to compare characteristics, Cochran-Armitage test to compare utilization rates, and Cochran-Armitage test and logistic regression to compare time-trends in outcomes by race.

Results

From 1998 to 2011, 176,141 Whites and 7694 Blacks underwent TSA. Compared to Whites, Blacks who underwent TSA were younger (69.1 vs. 64.2 years; p < 0.0001), more likely to be female (54.9 vs. 71.0 %; p < 0.0001), and have rheumatoid arthritis or avascular necrosis as the underlying diagnosis (1.7 vs. 3.0 % and 1.7 vs. 6.1 %; p < 0.0001 for both) and a Deyo-Charlson index of 2 or higher (8.5 vs. 16.7 %; p < 0.0001). Compared to Whites, Blacks had much lower TSA utilization rate/100,000 in 1998 (2.97 vs. 0.83; p < 0.0001) and in 2011 (12.27 vs. 3.33; p < 0.0001); racial disparities increased from 1998 to 2011 (p < 0.0001). A higher proportion of Blacks than Whites had a hospital stay greater than median in 1998–2000, 62 vs. 51.4 % (p = 0.02), and in 2009–2011, 34.4 vs. 27.3 % (p < 0.0001); disparities did not change over time (p = 0.31). These disparities in utilization were borderline significant in adjusted analyses. There were no racial differences in proportion discharged to inpatient medical facility in 1998–2000, 15.2 vs. 15.0 % (p = 0.95), and in 2009–2011, 12.3 vs. 11.1 % (p = 0.37), respectively.

Conclusions

We found increasing racial disparities in TSA utilization. Some disparities in outcomes exist as well. Patients, surgeons, and policy-makes should be aware of these findings and take action to reduce racial disparities.

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Contributors

JS designed the study. RR obtained the data and performed data programming and data analyses. JS and RR reviewed the analyses. JS drafted the first draft of the manuscript. RR made revisions and edits to the report. All authors approved the final version of the report.

Conflict of Interest

There are no financial or non-financial conflicts related directly to this study. JAS has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Ardea, and Regeneron. RR has no competing interests.

Grant Support

No direct funding was obtained for this study. JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. JAS is also supported by grants from the Agency for Healthcare Research and Quality and Centers for Education and Research on Therapeutics (AHRQ CERTs) U19 HS021110, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute of Aging (NIA), and National Cancer Institute (NCI) and research contract CE-1304-6631 from the Patient-Centered Outcomes Research Institute (PCORI).

Data Sharing

These data are publically available through the HCUP center.

We will share data with any investigator interested in replicating these findings or interested in future collaborations, pursuant to institutional and Institutional Review Board (IRB) regulations, in accordance with patient privacy, confidentiality, and HIPAA laws/regulations.

IRB Approval

The study was approved by the IRB at the University of Alabama at Birmingham.

Author information

Authors and Affiliations

  1. Birmingham VA Medical Center, Birmingham, AL, USA

    Jasvinder A. Singh

  2. Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA

    Jasvinder A. Singh & Rekha Ramachandran

  3. Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

    Jasvinder A. Singh

Authors
  1. Jasvinder A. Singh
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  2. Rekha Ramachandran
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Corresponding author

Correspondence to Jasvinder A. Singh.

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Singh, J.A., Ramachandran, R. Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes. J. Racial and Ethnic Health Disparities 3, 259–266 (2016). https://doi.org/10.1007/s40615-015-0138-3

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  • DOI: https://doi.org/10.1007/s40615-015-0138-3

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