Racial/Ethnic and Socioeconomic Disparities in Total Knee Arthroplasty 30- and 90-Day Readmissions: A Multi-Payer and Multistate Analysis, 2007-2014

Popul Health Manag. 2019 Apr;22(2):175-185. doi: 10.1089/pop.2018.0025. Epub 2018 Jun 29.

Abstract

Previous studies have addressed racial/ethnic and socioeconomic disparities in total knee arthroplasty (TKA) within the Medicare population. However, there is limited research examining these disparities across racial/ethnic and socioeconomic groups in the general population. This study used administrative data from the State Inpatient Databases from the Healthcare Cost and Utilization Project for the years 2007-2014 from California (2007-2011 only), Florida, New York, and Maryland (2012-2014 only). In all, 739,857 TKA readmission-eligible patients aged ≥8 years were included in the analysis. Black patients and patients with Medicaid had a higher likelihood of 30- and 90-day readmissions compared to white patients and patients with private insurance, respectively. Patients living in higher median income areas and patients treated at higher volume hospitals had lower likelihoods of 30- and 90-day readmissions compared to patients in the lowest median income quartile and patients treated at the lowest volume hospitals, respectively. These results confirmed racial/ethnic and socioeconomic disparities in TKA readmissions across 4 geographically diverse states, identified public insurance status as the salient factor across subpopulations, and raise awareness of the existence of these disparities outside of the Medicare population.

Keywords: administrative data; ethnicity; health disparities; health insurance; income; race.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Continental Population Groups / statistics & numerical data*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Male
  • Medicaid
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • United States / epidemiology