Purpose
To determine the use of operative rotator cuff repair for rotator cuff pathology in
New York State and analyze the racial, ethnic, and income-based disparities in receiving
rotator cuff repair.
Methods
A retrospective review of the Statewide Planning and Research Cooperative System Database
of New York State was conducted to include patients with a new diagnosis of rotator
cuff tear between July 1, 2017, and June 30, 2019, with at least 6 months of follow-up.
Bivariate analysis using χ2 tests and multivariable logistic regression models were used to determine racial,
ethnic, and income-based disparities in the use of surgical treatment with rotator
cuff repair.
Results
A total of 87,660 patients were included in the study. Of these, 36,422 patients (41.5%)
underwent surgical treatment with rotator cuff repair. Multivariable analysis showed
that Black race (adjusted odds ratio [aOR] 0.78; 95% confidence interval [CI] 0.69-0.87;
P < .001), Hispanic/Latino ethnicity (aOR 0.91; 95% CI 0.85-0.97); P = .004), and Medicaid (aOR 0.75; 95% CI 0.70-0.80; P < .001), or other government insurance (aOR 0.82; 95% CI 0.78-0.86; P < .001) were independently associated with lower rates of rotator cuff repair. Male
sex (aOR 1.18; 95% CI 1.14-1.22; P < .001), Asian race (aOR 1.27; 95% CI 1.00-1.62; P = .048), workers’ compensation insurance (aOR 1.12; 95% CI 1.07-1.18; P < .001), and greater home ZIP code income quartile (aOR 1.19; 95% CI 1.09-1.30; P < .001) were independently associated with greater rates of operative management.
Although race was an independent covariate affecting rate of rotator cuff repair,
the effects of race were altered when accounting for the other covariates, suggesting
that race alone does not account for the differences in rate of surgery for rotator
cuff pathology.
Conclusions
In this analysis of all adult patients presenting with rotator cuff tears to New York
hospital systems from 2017 to 2019, we identified significant racial, ethnic, and
socioeconomic disparities in the likelihood of rotator cuff repair surgery for patients
with rotator cuff tears. These include lower rates of rotator cuff repair for those
Black, Hispanic, and low-income populations as represented by Medicaid insurance and
low home ZIP code income quartile.
Clinical Relevance
This study reports disparities in the use of rotator cuff repair for individuals with
rotator cuff pathology.
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References
- Abnormal findings on magnetic resonance images of asymptomatic shoulders.J Bone Joint Surg Am. 1995; 77: 10-15
- Natural history of asymptomatic rotator cuff tears: A longitudinal analysis of asymptomatic tears detected sonographically.J Shoulder Elbow Surg. 2001; 10: 199-203
- Initial medical management of rotator cuff tears: A demographic analysis of surgical and nonsurgical treatment in the United States Medicare population.J Shoulder Elbow Surg. 2016; 25: e378-e385
- Prospective longitudinal analysis of postoperative shoulder function: A ten-year follow-up study of full-thickness rotator cuff tears.J Bone Joint Surg Am. 2001; 83: 1052-1056
- Ten-year clinical and anatomic follow-up after repair of anterosuperior rotator cuff tears: Influence of the subscapularis.J Shoulder Elbow Surg. 2017; 26: 1826-1833
- Long-term results of arthroscopic rotator cuff repair: initial tear size matters: A prospective study on clinical and radiological results at a minimum follow-up of 10 years.Am J Sports Med. 2019; 47: 2659-2669
- Treatment for rotator cuff tear is influenced by demographics and characteristics of the area where patients live.JB JS Open Access. 2018; 3e0005
- Analysis of risk factors, complications, reoperations, and demographics associated with open and arthroscopic rotator cuff repair: An analysis of a large national database.Arthroscopy. 2022; 38: 737-742
- The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting.J Gen Intern Med. 2010; 25: 982-988
- Disparities in cost and access by caseload for arthroscopic rotator cuff repair: An analysis of 18,616 cases.Orthop J Sports Med. 2019; 72325967119850503
- Perspectives of orthopedic surgeons on racial/ethnic disparities in care.J Racial Ethn Health Disparities. 2017; 4: 758-762
- Access disparities to Magnet hospitals for ischemic stroke patients.J Clin Neurosci. 2017; 43: 68-71
- Incidence and risk factors for peripheral nerve injury after 383,000 total knee arthroplasties using a New York State database (SPARCS).J Arthroplasty. 2019; 34: 2473-2478
- The trends in robotic-assisted knee arthroplasty: A statewide database study.J Orthop. 2019; 16: 298-301
- Trends and disparities in cervical spine fusion procedures utilization in the New York State.Spine (Phila Pa 1976). 2018; 43: E601-E606
- Race and insurance status are associated with surgical management of isolated meniscus tears.Arthroscopy. 2018; 34: 2677-2682
- Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology.Am J Public Health. 1992; 82: 703-710
- Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States.Vasc Med. 2015; 20: 439-446
- Racial disparities are present in the timing of radiographic assessment and surgical treatment of hip fractures.Clin Orthop Relat Res. 2020; 478: 455-461
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.in: Smedley B.D. Stith A.Y. Nelson A.R. Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press (US), Washington (DC)2003
- Racial disparities in knee and hip total joint arthroplasty: An 18-year analysis of national Medicare data.Ann Rheum Dis. 2014; 73: 2107-2115
- Racial and sex disparities in utilization rates for shoulder arthroplasty in the United States disparities in shoulder arthroplasty.J Orthop. 2019; 16: 195-200
- United States hospital admissions for lumbar spinal stenosis: Racial and ethnic differences, 2000 through 2009.Spine (Phila Pa 1976). 2013; 38: 2272-2278
- Determinants of patient preferences for total knee replacement: African-Americans and whites.Arthritis Res Ther. 2015; 17: 348
- "It's not what you say ...": racial disparities in communication between orthopedic surgeons and patients.Med Care. 2008; 46: 410-416
- Racial and ethnic disparities in health insurance coverage: Dynamics of gaining and losing coverage over the life-course.Popul Res Policy Rev. 2017; 36: 181-201
- Geographic variation and disparities in total joint replacement use for Medicare beneficiaries: 2009 to 2017.J Bone Joint Surg Am. 2020; 102: 2120-2128
- A regional assessment of medicaid access to outpatient orthopaedic care: The influence of population density and proximity to academic medical centers on patient access.J Bone Joint Surg Am. 2014; 96: e156
- Delay to arthroscopic rotator cuff repair is associated with increased risk of revision rotator cuff surgery.Orthopedics. 2020; 43: 340-344
- The effects of hospital and surgeon volume on postoperative complications after lumbar spine surgery.Spine (Phila Pa 1976). 2011; 36: 2069-2075
- Patient outcomes as a function of shoulder surgeon volume: A systematic review.Arthroscopy. 2017; 33: 1273-1281
- Total arthroplasty versus hemiarthroplasty for glenohumeral osteoarthritis: Role of provider volume.J Shoulder Elbow Surg. 2005; 14: 361-367
- National disparities in access to physical therapy after rotator cuff repair between patients with Medicaid vs. private health insurance.JSES Int. 2021; 5: 507-511
- Non-Operative Management of Rotator Cuff Tears.Open Orthop J. 2016; 10: 349-356
- Patients' preoperative expectations predict the outcome of rotator cuff repair.J Bone Joint Surg Am. 2007; 89: 1913-1919
- Rehabilitation following arthroscopic rotator cuff repair: A review of current literature.J Am Acad Orthop Surg. 2014; 22: 1-9
- A comparison of rehabilitation methods after arthroscopic rotator cuff repair: A systematic review.Sports Health. 2015; 7: 326-334
- Current concepts in orthopaedic care disparities.J Am Acad Orthop Surg. 2018; 26: 823-832
- Designing an intervention to improve management of high-risk lupus patients through care coordination.Rheum Dis Clin North Am. 2020; 46: 723-734
Article info
Publication history
Published online: July 07, 2022
Accepted:
June 23,
2022
Received:
November 14,
2021
Footnotes
See commentary on page 3011
The authors report the following potential conflicts of interest or sources of funding: M.M. reports payment and stock, Scientific Advisory Board for Concentric Analgesics; consultant, Faculty for Fellows Course, Speakers Bureau, for Arthrex; payment for expert testimony; and speakers’ bureau, Arthrex, outside the submitted work. I.V. reports consultant from Arthrex, ZimmerBiomet, Olympus, FH Orthopedics, Smith & Nephew, Tenoclip; payment for lectures, including service on speakers’ bureaus; royalties from Smith and Nephew and Innomed; and payment for the development of educational programs, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Statewide Planning and Research Cooperative System Disclaimer: This publication was produced from raw data purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived, and views expressed herein are those of the author(s) and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here.
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© 2022 by the Arthroscopy Association of North America
