Examining Differences Between Groups by Race, Sex, and Insurance Status in Treatment of Rotator Cuff Pathology
Keywords:rotator cuff, disparities, inequity
Statement of Significance
The purpose of this study was to investigate disparities in the treatment of rotator cuff pathology by sex, race, and insurance status. The findings suggested that disadvantaged groups did not receive less interventions within the clinic of interest. The study was limited by a small sample size in a single clinic in rural North Carolina. Future studies are needed to make the findings generalizable across different clinic settings.
Background: Rotator cuff pathology (RCP) affects a significant portion of the global population and can cause notable pain and reduction in function. Many treatment options exist for RCP, including physical therapy, injections, and surgery. Literature indicates management disparities exist between demographic groups, such as racial self-identity, gender, and socioeconomic status. Studies suggest women, non-white patients, and those of low socioeconomic status are less likely to receive definitive surgical treatment and experience increased time from presentation to surgery.
Methods: We conducted a retrospective chart review to determine if race, gender, or socioeconomic status affected treatment decisions for RCP at a sports medicine clinic in western North Carolina. Data from patients with clinically suspected RCP from January 2018–April 2020 were assessed for associations between demographic factors and differences in the management. Management options included MRI, physical therapy, injection, or referral to orthopedic surgery.
Results: 178 patients were included in the study. There was not a statistically significant difference in treatments between genders, although females showed a trend towards more referrals to orthopaedic surgery (p=0.06). Non-white patients were found to receive MRI at a higher rate (p<0.05), but race and insurance status otherwise exhibited no significant differences in management.
Conclusions: Our data did not observe management disparities based on sex, race, or insurance status, which was used as a surrogate for socioeconomic status, in the sample population.
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Copyright (c) 2021 Anthony V. Paterno, MS, Bryan A. Chadwick, Jackson S. Perry, Daniel E. Marks, MS, Jessica A. Knapp, DO
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