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Worsening Arthroplasty Utilization With Widening Racial Variance During the COVID-19 Pandemic
Benjamin M Stronach1, Xiaoran Zhang2, Derek Haas2
1Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
Insights
The COVID-19 pandemic reduced arthroplasty surgery rates, disproportionately affecting racial disparities in care. Non-White patients experienced greater decreases in total joint arthroplasty utilization, worsening existing inequities.
Area of Science:
- Orthopedic Surgery
- Public Health
- Health Equity
Background:
- Elective arthroplasty surgeries in the U.S. were significantly impacted by the COVID-19 pandemic.
- Racial disparities in healthcare access and utilization have been a persistent concern, amplified during the pandemic.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on arthroplasty utilization trends.
- To assess the independent and combined effects of race and the pandemic on arthroplasty rates.
Main Methods:
- Analysis of 2019 and 2020 Medicare fee-for-service claims data.
- Comparison of arthroplasty volumes before and during the COVID-19 pandemic.
- Stratification of utilization rates by race to identify disparities.
Main Results:
- Overall arthroplasty utilization decreased between 2019 and 2020, with notable drops in primary total knee (-28%) and hip (-14%) arthroplasties.
- The Hispanic population experienced the largest decrease in arthroplasty utilization (34%).
- Non-White patients were less likely to receive total joint arthroplasty pre-pandemic, and the pandemic further reduced their access by 12.9%.
Conclusions:
- The COVID-19 pandemic led to decreased arthroplasty utilization across all populations.
- Pandemic-related decreases were more pronounced in non-White populations, exacerbating pre-existing racial disparities.
- Urgent attention is needed to address worsening racial inequities in arthroplasty care.
Background:
Elective arthroplasty surgery in the United States came to a near-complete halt in the spring of 2019 as a response to the COVID-19 pandemic. Racial disparity has been a long-term concern in healthcare with increased focus during the pandemic. The purpose of this study is to evaluate the effects of COVID-19 and race on arthroplasty utilization trends during the pandemic.
Methods:
We used 2019 and 2020 Center for Medicare and Medicaid Service fee-for-service claims data to compare arthroplasty volumes prior to and during the COVID-19 pandemic. We compared overall arthroplasty utilization rates between 2019 and 2020 and then sought to determine the effect of race and COVID-19, both independently and combined.
Results:
There was a decrease in primary total knee arthroplasty (-28%), primary total hip arthroplasty (-14%), primary total hip arthroplasty for fracture (-2%), and revision arthroplasty (-14%) utilization between 2019 and 2020. The highest decrease in overall arthroplasty utilization was in the Hispanic population (34% decrease vs 19% decrease in the White population). We found that a non-White patient was 39.9% (P < .001) less likely to receive a total joint arthroplasty prior to COVID-19. The COVID-19 pandemic further exacerbated the pre-existing racial differences in arthroplasty utilization by decreasing the probability of receiving a total joint arthroplasty for non-White patient by another 12.9% (P < .001).
Conclusion:
We found an overall decreased utilization rate of arthroplasty during the COVID-19 pandemic with further decrease noted in all non-White populations. This raises significant concern for worsening racial disparity in arthroplasty caused by the ongoing pandemic.
