Shoulder Arthroplasty Utilization Based on Race - Are Black Patients Underrepresented?

Abstract

Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization based<br />on patient race.<br />Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplasty<br />utilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoing<br />shoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-black<br />subpopulations.<br />Results: The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted<br />3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of<br />1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Females<br />accounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001)<br />and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type,<br />1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of five<br />major insurance categories, including private, Medicare, Medicaid, workers' compensation, and personal injury,<br />indicated no difference in insurance patterns (χ2=3.658, P=0.454).<br />Conclusion: The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national and<br />institutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Black<br />patients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-black<br />patients. The obtained results highlighted the need for the expansion of black patients' access to care services related<br />to major joint reconstruction.<br />Level of evidence: III