Disparities in arthroplasty utilization for rotator cuff tear arthropathy

Area of Science:

• Orthopedic surgery
• Musculoskeletal medicine
• Health services research

Background:

• Rotator cuff tear arthropathy (CTA) causes significant patient suffering.
• Reverse shoulder arthroplasty (RSA) is an effective treatment for CTA.
• Social determinants of health (SDOH) impact musculoskeletal medicine utilization, but data on RSA is limited.

Purpose of the Study:

• To investigate the influence of SDOH on RSA utilization rates for CTA patients.
• To identify potential disparities in access to this orthopedic intervention.

Main Methods:

• Retrospective review of adult CTA patients (2015-2020) at a single center.
• Comparison of patients who underwent RSA versus those offered but declined surgery.
• Analysis of zip code-based median household income, HUD, and Federal Reserve income data.
• Grouping patients into racial cohorts: Black, White, and other races.

Main Results:

• Patients of 'other races' had significantly lower odds of undergoing RSA compared to White patients, even after controlling for income.
• Lower odds of RSA utilization were observed for patients below median income levels when compared to low HUD income groups.
• No significant difference in RSA utilization was found based on Federal Reserve income levels or general median household income.

Conclusions:

• Findings indicate disparities in RSA utilization among ethnic minorities, distinct from Black patients.
• Current utilization improvement efforts may not adequately address needs of all minority groups.
• Understanding SDOH is crucial for reducing access barriers and improving orthopedic care equity for CTA patients.