Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

Area of Science:

• Orthopedic surgery
• Health services research
• Health disparities

Background:

• Medicare provides near-universal health insurance to US residents aged 65 years or older.
• The impact of Medicare eligibility on racial and ethnic disparities in orthopedic trauma care is not well understood.

Purpose of the Study:

• To assess the association between Medicare eligibility and racial/ethnic disparities in open reduction and internal fixation (ORIF) following distal radius fractures (DRF).
• To investigate how the transition to Medicare at age 65 influences surgical management disparities.

Main Methods:

• Retrospective cohort study using Healthcare Cost and Utilization Project databases (Florida, Maryland, New York).
• Included patients aged 57-72 years with DRFs (2016-2019).
• Regression discontinuity design and multivariable logistic regression analyzed racial/ethnic disparities in ORIF rates before and after Medicare eligibility (age 65).

Main Results:

• A total of 26,874 patients with DRF were analyzed; 32.6% received ORIF.
• Black (20.2%) and Hispanic (25.8%) patients had significantly lower ORIF rates compared to White patients (35.4%).
• Medicare eligibility did not significantly alter these disparities; the disparity in ORIF use between White and Black patients was 9.4 percentage points greater than expected post-Medicare eligibility.

Conclusions:

• Surgical management, specifically ORIF, for DRFs is common in adults aged 57-72.
• Racial and ethnic minority patients experience lower rates of ORIF for DRFs.
• Medicare eligibility at age 65 does not mitigate existing racial and ethnic disparities in the surgical management of DRFs.