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Author Notes:

Uma Srikumaran, MD, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA. Email: us@jhmi.edu

Matthew J. Best: Reports other financial or material support from Arthrex, Inc and Smith & Nephew. Catherine J. Fedorka, MD: Reports personal fees from Stryker. Robert M. Belniak, MD: Reports presenter fees from Pacira and ownership of stock in Stryker. Derek A. Haas, MBA: Reports ownership of stock in Avant-gard Health and personal fees from Medacta. April D. Armstrong, MD: Reports personal fees from Globus Medical, IP royalties from Zimmer and membership on the editorial or governing board of Journal of Shoulder and Elbow Surgery. Joseph A. Abboud, MD: ownership of stock in Aevumed, research support from Arthrex, personal fees from Bioventus, research support from the Department of Defense, IP royalties and personal fees from DJ Orthopaedics, IP royalties and personal fees Globus Medical, membership on the editorial or governing board of Journal of Shoulder and Elbow Surgery, membership on the editorial or governing board of research support from Lima, ownership of stock in Marlin Medical Alliance, ownership of stock in OBERD, research support from OREF, research support from Orthofix, IP royalties from OsteoCentric Technologies. ownership of stock in OTS Medical, ownership of stock in Shoulder JAM, financial or material support from SLACK Incorporated, IP royalties from Smith and Nephew, IP royalties and personal fees from Stryker, publishing royalties and financial or material support from Wolters Kluwer Health – Lippincott Williams & Wilkins, IP royalties, personal fees and research support from Zimmer. Andrew Jawa, MD: Reports other financial or material support from Boston Outpatient Surgical Suites, other financial or material support from DePuy, A Johnson & Johnson Company, personal fees and research support from DJ Orthopaedics, IP royalties and ownership of stock from Ignite Orthopaedics, membership on the editorial or governing board of Journal of Shoulder and Elbow Surgery, publishing royalties and other financial or material support from Oberd. Jason E. Simon, MD: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Eric R. Wagner, MD: Reports personal fees from Acumed, personal fees from Biomet, research support from Konica Minolta, personal fees from Osteoremedies, and personal fees from Stryker. Michael B. Gottschalk, MD: Reports research support from Konica Minolta and research support from Stryker. Eric C. Makhni, MD: Reports ownership of stock in OutcomeMD, ownership of stock in Proterea Health, personal fees from Smith & Nephew and publishing royalties and financial or material support from Springer. Jon JP Warner, MD: Reports membership on the editorial or governing board of Journal of Shoulder and Elbow Surgery, other financial or material support from Smith & Nephew, personal fees from Stryker and IP royalties and personal fees from Wright Medical Technology. Uma Srikumaran, MD, MBA, MPH: Reports grants and personal fees from Arthrex, grants and personal fees from Depuy, personal fees from Fx Shoulder, personal fees from Orthofix, other from Quantum OPS, other from ROM3, grants from Smith and Nephew, other from Sonogen, personal fees from Stryker, personal fees from Thieme, personal fees and other from Tigon Medical, grants and personal fees from Wright Medical Technology, outside the submitted work; In addition, Dr. Srikumaran has a patent Conventus pending, a patent Fx Shoulder pending, and a patent Tigon Medical issued. The other authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Institutional review board approval was not required for this study.

Subject:

Research Funding:

No financial support was used for this manuscript.

Keywords:

  • COVID-19
  • Coronavirus pandemic
  • Racial disparities
  • Shoulder
  • TSA
  • Total shoulder arthroplasty

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

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Journal Title:

JSES International

Volume:

Volume 7, Number 2

Publisher:

, Pages 252-256

Type of Work:

Article | Final Publisher PDF

Abstract:

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.

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