The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States

Matthew J. Best, MD; Catherine J. Fedorka, MD; Robert M. Belniak, MD; Derek A. Haas, MBA; Xiaoran Zhang, MA; April D. Armstrong, MD; Joseph A. Abboud, MD; Andrew Jawa, MD; Evan A. O’Donnell, MD; Jason E. Simon, MD; Eric R. Wagner, MD; Momin Malik, PhD; Michael B. Gottschalk, MD; Adam Z. Khan, MD; Gary F. Updegrove, MD; Eric C. Makhni, MD; Jon J.P. Warner, MD; Uma Srikumaran, MD, MBA, MPH

JSES International (Mar 2023)

The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States

Matthew J. Best, MD,
Catherine J. Fedorka, MD,
Robert M. Belniak, MD,
Derek A. Haas, MBA,
Xiaoran Zhang, MA,
April D. Armstrong, MD,
Joseph A. Abboud, MD,
Andrew Jawa, MD,
Evan A. O’Donnell, MD,
Jason E. Simon, MD,
Eric R. Wagner, MD,
Momin Malik, PhD,
Michael B. Gottschalk, MD,
Adam Z. Khan, MD,
Gary F. Updegrove, MD,
Eric C. Makhni, MD,
Jon J.P. Warner, MD,
Uma Srikumaran, MD, MBA, MPH

Affiliations

Matthew J. Best, MD: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
Catherine J. Fedorka, MD: Cooper Bone and Joint Institute, Camden, NJ, USA
Robert M. Belniak, MD: Department of Orthopaedic Surgery and Sports Medicine, Starling Physicians Group, New Britain, CT, USA
Derek A. Haas, MBA: Avant-garde Health, Boston, MA, USA
Xiaoran Zhang, MA: Avant-garde Health, Boston, MA, USA
April D. Armstrong, MD: Department of Orthopaedics and Rehabilitation, Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
Joseph A. Abboud, MD: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
Andrew Jawa, MD: Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
Evan A. O’Donnell, MD: Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA
Jason E. Simon, MD: Department of Orthopaedic Surgery, Harvard Medical School, Newton-Wellesley Hospital, Boston, MA, USA
Eric R. Wagner, MD: Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
Momin Malik, PhD: Avant-garde Health, Boston, MA, USA
Michael B. Gottschalk, MD: Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
Adam Z. Khan, MD: Northwest Permanente Physicians and Surgeons, Clackamas, OR, USA
Gary F. Updegrove, MD: Department of Orthopaedics and Rehabilitation, Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
Eric C. Makhni, MD: Department of Orthopaedic Surgery, Sports Medicine, Henry Ford Health, Detroit, MI, USA
Jon J.P. Warner, MD: Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA
Uma Srikumaran, MD, MBA, MPH: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA; Corresponding author: Uma Srikumaran, MD, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.

Journal volume & issue: Vol. 7, no. 2
pp. 252 – 256

Abstract

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Introduction: The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the United States and to determine whether these disparities were affected by the COVID-19 pandemic. Methods: Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April to December from 2019 to 2020. Utilization was assessed for White, Black, Hispanic, and Asian populations to determine if COVID-19 affected these groups differently. A regression model adjusted for age, sex, CMS-hierarchical condition categories (HCC) score, dual enrollment (proxy for socioeconomic status), time-fixed effects, and core-based statistical area fixed effects was used to study difference across groups. Results: In 2019, the TSA volume per 1000 beneficiaries was 1.51 for White and 0.57 for non-White, with a 2.6-fold difference. In 2020, the rate of TSA in White patients (1.30/1000) was 2.9 times higher than non-White (0.45/1000) during the COVID-19 pandemic (P < .01). There was an overall 14% decrease in TSA volume per 1000 Medicare beneficiaries in 2020; non-White patients had a larger percentage decrease in TSA volume than White (21% vs. 14%, estimated difference; 8.7%, P = .02). Black patients experienced the most pronounced disparity with estimated difference of 10.1%, P = .05, compared with White patients. Similar disparities were observed when categorizing procedures into anatomic and reverse TSA, but not proximal humerus fracture. Conclusions: During the COVID-19 pandemic, overall TSA utilization decreased by 14% with White patients experiencing a decrease of 14%, and non-White patients experiencing a decrease of 21%. This trend was observed for elective TSA, while disparities were less apparent for proximal humerus fracture.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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