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

Document Type : RESEARCH PAPER


1 Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA

2 Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA


Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization based
on patient race.
Methods: 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
Results: 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, P<0.0001)
and were younger (62.6 vs. 67.2 years, P<0.0001), 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 (χ2=3.658, P=0.454).
Conclusion: 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.
Level of evidence: III


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