Gatto Andrew P, Feeley Brian T, Lansdown Drew A
Touro University California, College of Osteopathic Medicine, Vallejo, CA, USA.
Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
JSES Rev Rep Tech. 2021 Oct 23;2(1):26-34. doi: 10.1016/j.xrrt.2021.09.007. eCollection 2022 Feb.
Poor socioeconomic status (SES) is consistently associated with poor quality of health care, particularly in the field of orthopedics. Expanding insurance coverage has created a larger patient population by specifically making health care more accessible, translating to greater demand for care in the low-SES population. The purpose of this article is to provide a scoping review of literature observing access and outcomes of rotator cuff repair surgery among low-SES populations.
We performed a systematic review of articles using PubMed, Embase, and EBSCO (May 2021) from 2010 onward. Peer-reviewed articles that recorded at least one SES measure specific to patients who underwent rotator cuff repair from the United States were included. SES measures were methodically defined as income, occupation, employment, education, and race. All data that aligned with these SES measures were extracted.
Of the 1009 titles reviewed, 109 studies were screened by abstract, 23 were reviewed in full, and 7 studies met criteria for inclusion. Of the 5 studies investigating access, all 5 found disparities among postoperative physical therapy, orthopedic consult, and surgery, using Medicaid status as a proxy for income in addition to other income measures. Of the 3 studies analyzing outcomes, 2 found that low-SES patients had worse pain and function, again based on Medicaid status and other income measures. Education did not have a significant impact on outcomes, as per the 1 study that included it. No studies included measures of occupation or employment.
Patients of low SES face reduced access to cuff repair care and worse associated outcomes, despite federal and state government efforts to reduce health care disparity through health care reform. The small nature of this review reflects how measures of SES are often not examined in rotator cuff repair studies.
社会经济地位低下（SES）一直与医疗保健质量差相关，尤其是在骨科领域。扩大保险覆盖范围通过使医疗保健更易获得，从而增加了患者群体，这意味着低收入SES人群对医疗服务的需求更大。本文的目的是对观察低收入SES人群肩袖修复手术的可及性和结果的文献进行范围综述。
我们使用PubMed、Embase和EBSCO（2021年5月）对2010年以后的文章进行了系统综述。纳入了经同行评审的文章，这些文章记录了至少一项针对来自美国接受肩袖修复的患者的SES指标。SES指标被系统地定义为收入、职业、就业、教育和种族。提取了所有与这些SES指标相符的数据。
在审查的1009篇标题中，通过摘要筛选了109项研究，对23项进行了全文审查，7项研究符合纳入标准。在调查可及性的5项研究中，所有5项研究都发现，除了其他收入指标外，以医疗补助状态作为收入的替代指标，术后物理治疗、骨科会诊和手术存在差异。在分析结果的3项研究中，2项研究发现，同样基于医疗补助状态和其他收入指标，低收入SES患者的疼痛和功能更差。根据纳入教育指标的1项研究，教育对结果没有显著影响。没有研究纳入职业或就业指标。
尽管联邦和州政府努力通过医疗改革减少医疗保健差距，但低收入SES患者接受肩袖修复治疗的机会减少，且相关结果更差。本综述规模较小，反映出肩袖修复研究中往往未对SES指标进行考察。
