Shoulder Arthroplasty Utilization by Race - Are Black Patients Under-Represented?

INTRODUCTION The purpose of this study is to analyze national and institutional trends in shoulder arthroplasty utilization by race. METHODS The Nationwide Inpatient Sample (NIS) was analyzed to determine racial trends in shoulder arthroplasty utilization nationally. An institutional database was then utilized to retrospectively identify all patients undergoing shoulder arthroplasty from 2011-2013. Descriptive statistics were utilized to compare self-identified black and non-black subpopulations. RESULTS The NIS identified 256,832 primary shoulder arthroplasties from 2005 to 2011. There were 10,074 (3.92%) cases performed in black patients. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, 1,174 primary shoulder arthroplasties were performed, 70 (5.96%) were black patients. Females accounted for 48/70 (68.6%) of black patients. Black patients had higher BMI (33.6 versus 30.1, p<0.0001) and were younger (62.6 versus 67.2 years, p<0.0001). Regarding insurance type, 1074 (65 black, 1009 non-black) patients had comprehensive insurance data. Chi square analysis of five major insurance categories (private, Medicare, Medicaid, workman’s compensation, and personal injury) found no difference in insurance patterns (χ2= 3.658, p= 0.454). CONCLUSIONS Significant racial disparity in shoulder arthroplasty utilization exists at the national and institutional level. This disparity exists despite similar rates of osteoarthritis in white and black patients. Black patients at our institution had similar clinical, demographic, and socioeconomic patterns as our non-black patients. These results further highlight the need for expanding access of care to black patients in major joint reconstruction.