Black Race, Hispanic Ethnicity, and Medicaid Insurance Are Associated With Lower Rates of Rotator Cuff Repair in New York State

Alan Hwang*, Linda Zhang, Gabriel Ramirez, Michael Maloney, Ilya Voloshin, Caroline Thirukumaran

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3001-3010.e2
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume38
Issue number11
DOIs
StatePublished - Nov 2022

Funding

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.

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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