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Multicenter Study
. 2015 Mar 21;17(1):70.
doi: 10.1186/s13075-015-0589-2.

Racial disparities in total ankle arthroplasty utilization and outcomes

Jasvinder A Singh  1   2   3 , Rekha Ramachandran  4
Affiliations
Multicenter Study

Racial disparities in total ankle arthroplasty utilization and outcomes

Jasvinder A Singh et al. Arthritis Res Ther. .

Abstract

Introduction: The objective of this study was to examine the racial disparities in total ankle arthroplasty (TAA) utilization and outcomes.

Methods: We used the National Inpatient Sample (NIS) to study the time-trends. Race was categorized as White and Black. Utilization rates were calculated for the U.S. general population per 100,000. Hospital length of stay, discharge disposition and mortality after TAA were assessed. We used the Cochran Armitage trend test to assess time-trends from 1998 to 2011 and chi-square test to compare TAA utilization. We used analysis of variance or chi-squared test to compare the characteristics of Whites and Blacks undergoing TAA and logistic regression to compare mortality, length of stay and discharge to home versus medical facility.

Results: The mean ages for Whites undergoing TAA were 62 years and for Blacks was 52 years. Significant racial disparities were noted in TAA utilization rates (/100,000) in 1998, 0.14 in Whites vs. 0.07 in Blacks (P<0.0001; 2-fold) and in 2011, 1.17 in Whites vs. 0.33 in Blacks (P<0.0001; 4-fold). Racial disparities in TAA utilization increased significantly from 1998 to 2011 (P<0.0001). There was a trend towards statistical significance for the difference in the length of hospital stay in Blacks vs. Whites (52.9% vs. 44.3% with length of hospital stay higher than the median; P=0.08). Differences in the proportion discharged to an inpatient medical facility after TAA, 16.6% Blacks vs. 13.4% Whites, were not significant (P=0.36).

Conclusions: This study demonstrated significant racial disparities with lower TAA utilization and suboptimal outcomes in Blacks compared to Whites. Further studies are needed to understand the mediators of these disparities and to assess whether these mediators can be targeted to reduce racial disparities in TAA.

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Figures

Figure 1
Figure 1
Total ankle arthroplasty utilization rates per 100,000 in Whites and Blacks over time.
Figure 2
Figure 2
Age-specific total ankle arthroplasty utilization rates per 100,000 for Whites and Blacks. (A) Age-specific rates for Whites. Cochran Armitage test comparing total ankle arthroplasty (TAA) utilization in all years: age <50, P = 0.11; age 50 to 64, P <0.0001; age 65 to 79, P <0.0001; age ≥80, P <0.0001. (B) Age-specific rates for Blacks. Cochran Armitage test comparing TAA utilization in all years: age <50, P = 0.07; age 50 to 64, P = 0.053; age 65 to 79, P = 0.009; age ≥80, P = 0.0002.
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