Tompson Jeffrey D, Syed Usman A, Padegimas Eric M, Abboud Joseph A
Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA.
Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA.
Arch Bone Jt Surg. 2019 Nov;7(6):484-492.
This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization based on patient race.
The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplasty utilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoing shoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-black subpopulations.
The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted 3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of 1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Females accounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, ) and were younger (62.6 vs. 67.2 years, ), compared to the non-black patients. Regarding insurance type, 1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of five major insurance categories, including private, Medicare, Medicaid, workers' compensation, and personal injury, indicated no difference in insurance patterns (χ=3.658, ).
The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national and institutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Black patients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-black patients. The obtained results highlighted the need for the expansion of black patients' access to care services related to major joint reconstruction.
本研究旨在分析基于患者种族的肩关节置换术使用情况的全国和机构趋势。
使用全国住院患者样本（NIS）来确定全国范围内肩关节置换术使用情况的种族趋势。然后利用一个机构数据库回顾性地识别2011年至2013年期间接受肩关节置换术的所有患者。使用描述性统计来比较自我认定的黑人和非黑人亚人群。
NIS在2005年至2011年期间识别出256,832例初次肩关节置换术。黑人患者占病例的3.92%（n = 10,074）。使用率从2005年的3.36%上升至2011年的4.49%。在当地，共进行了1,174例初次肩关节置换术，其中黑人患者占5.96%（n = 70）。女性占黑人患者的48/70（68.6%）。与非黑人患者相比，黑人患者的体重指数更高（33.6对30.1），且更年轻（62.6岁对67.2岁）。关于保险类型，1,074例患者（即65例黑人患者和1,009例非黑人患者）有完整的保险数据。对包括私人保险、医疗保险、医疗补助、工伤赔偿和人身伤害在内的五大保险类别进行卡方分析，结果表明保险模式没有差异（χ = 3.658）。
研究结果显示，在全国和机构层面，肩关节置换术的使用存在显著的种族差异。尽管白人和黑人患者的骨关节炎发病率相似，但这种差异仍然存在。我们机构中的黑人患者在临床、人口统计学和社会经济特征方面与非黑人患者相似。所得结果凸显了扩大黑人患者获得与主要关节重建相关护理服务机会的必要性。
