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. 2015:2015:1-8.
doi: 10.1007/s40615-015-0138-3.

Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes

Jasvinder A Singh  1 , Rekha Ramachandran  2
Affiliations

Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes

Jasvinder A Singh et al. J Racial Ethn Health Disparities. 2015.

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.

Keywords: Discharge; Hospital stay; Mortality; Outcomes; Race; TSA; Time-trends; Total shoulder arthroplasty; Utilization.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Time-trends in TSA Black White utilization by race
Fig. 2
Fig. 2
Race-specific time-trends in TSA utilization in Black and White patients by gender (a, b) and age group in Whites (c) and Blacks (d)
See this image and copyright information in PMC

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