Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
A recent study that used the 1993-2007 U.S. Nationwide Inpatient Sample (NIS) reported that Blacks had lower overall Total Shoulder Arthroplasty (TSA) utilization rates compared to Whites with a risk ratio of 0.6. It is not known, whether the racial disparity in TSA utilization is increasing or decreasing in the U.S. Our objective was to study whether racial disparities in total shoulder arthroplasty (TSA) utilization and outcomes have declined over time in the U.S.
Methods:
We used the U.S. Nationwide Inpatient Sample from 1998-2011. We used chi-squared test to compare characteristics, Cochran-Armitage test to compare utilization rates, and Cochran-Armitage test and logistic regression to compare time-trends in outcomes by race.
Results:
176,141 Whites and 7,694 Blacks underwent TSA from 1998-2011. Compared to Whites, Blacks who underwent TSA were younger (69.1 vs. 64.2 years; p<0.0001) and more likely to be female (54.9% vs. 71.0%; p<0.0001), have rheumatoid arthritis or avascular necrosis as the underlying diagnosis (1.7% vs. 3.0% and 1.7% vs. 6.1 %; p<0.0001 for both) and Deyo-Charlson index of 2 or higher (8.5% vs. 16.7%; p<0.0001). Compared to Whites, Blacks had much lower TSA utilization rate/100,000 in 1998 (2.97 vs. 0.83; p<0.0001) and in 2011 (12.27 vs. 3.33; p<0.0001); disparities increased from 1998 to 2011 (p<0.0001). A higher proportion of Blacks than Whites had hospital stay greater than median in 1998-2000, 62% vs. 51.4% (p=0.02) and in 2009-2011, 27.3% vs. 34.4% (p<0.0001); disparities did not change over time (p=0.31). These disparities were borderline significant in adjusted analyses. There were no racial differences in proportion discharged to inpatient medical facility in 1998-2000, 15.2% vs. 15.0% (p=0.95) and in 2009-2011, 12.3% vs. 11.1% (p=0.37), respectively.
Conclusion:
We found increasing racial disparities in TSA utilization. Some disparities in outcomes exist as well. Patients, surgeons and policy-makes should be aware of these findings and take action to reduce racial disparities.
To cite this abstract in AMA style:
Singh JA, Ramachandaran R. Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes Are Persisting [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/racial-disparities-in-total-shoulder-arthroplasty-utilization-and-outcomes-are-persisting/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-disparities-in-total-shoulder-arthroplasty-utilization-and-outcomes-are-persisting/