Wednesday, August 5, 2015

Shoulder arthroplasty and race in New York State

Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization.

These authors assessed the demographic patterns and utilization rates of shoulder arthroplasty in New York State from 1991 to 2010, using the New York Statewide Planning and Research Cooperative System database.

During the 20-year period, 24,040 shoulder arthroplasty procedures were performed. During the second decade (2001-2010), there was a 393% increase in utilization of total shoulder arthroplasty (including reverse total shoulder) with a 98% increase in hemiarthroplasty.

Also notable was an identifiable disparity in race; whites represented approximately 80% of the shoulder arthroplasty procedures in both decades, whereas African Americans made up <5%. 

Comment: This racial distribution is significantly different from the general racial demographics of New York state

White                        62.6%
Hispanic or Latino    17.1%
Black                         13.2%
Asian                           5.3%
American native          1.2%

The authors are in a position to answer some critical questions that may clarify the reason for this apparent racial disparity in shoulder arthroplasty:

(1) How do the diagnoses vary among these racial groups (do some have higher rates of avascular necrosis, rheumatoid arthritis, traumatic arthritis, cuff tear arthropathy than others)? Some races appear to have quite difference prevalences of these diagnoses than others.
(2) How does the type of insurance (commercial, workers' compensation, Medicare, Medicaid, self pay) vary among these racial groups?

We are all interested in assuring access to health care for those who need it. Now is the time to collect some good data that will inform our efforts to assure this access.


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