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Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis
Samuel S Rudisill1,2, Alexander L Hornung1,2, Nathan H Varady1
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Background:
Hip fractures are common injuries that result in substantial loss of quality of life to elderly patients. To date, no meta-analyses have been performed to consolidate findings related to racial and ethnic disparities in hip fracture care.
Purpose:
We sought to examine associations between racial or ethnic identity and several metrics of hip fracture care.
Methods:
For a systematic review and meta-analysis, we searched PubMed, Scopus, CINAHL, and SPORTDiscus databases in December 2021 for articles examining racial and ethnic disparities in hip fracture surgery among White, Black, Hispanic, Asian, Pacific Islander (PI), and American Indian/Alaska Native (AIAN) patients. Twenty-three studies reported time to surgery (TTS), complications, mortality, length of stay (LOS), discharge disposition, readmissions, or reoperations. Meta-analyses were conducted for outcomes for which there were at least 3 comparable studies with requisite data available.
Results:
Compared with White patients, Black patients experienced greater rates of TTS longer than 2 days, 30-day complication, 90-day readmission, 1-year reoperation, and longer LOS, though odds of 30-day mortality were reduced. Hispanic patients had higher 90-day complication rates and longer LOS but lower risk of mortality and nonhome discharge than other racial and ethnic groups. Time to surgery of longer than 2 days was more common among Asian patients, though mortality, nonhome discharge, and readmission rates were lower. There were higher mortality rates in White patients compared with Hispanic patients at all timepoints and compared with Black patients until 1 year following surgery, when rates were higher among Black patients.
Conclusions:
This systematic review and meta-analysis found evidence of disparities in hip fracture surgery, with minority patients facing greater rates of surgical delay and perioperative complications. Even though the studies may not have been uniform in defining race or ethnicity or in accounting for the effects of systemic racism, these findings suggest that concerted efforts are needed to understand these gaps and promote equity in hip fracture care.
