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. 2022 Jul 29;6(7):e22.00126.
doi: 10.5435/JAAOSGlobal-D-22-00126. eCollection 2022 Jul 1.

Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States

Andrew J Landau  1 , Afolayan K Oladeji, Pooya Hosseinzadeh
Affiliations

Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States

Andrew J Landau et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Introduction: Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures.

Methods: The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment.

Results: State databases identified 130,006 forearm (1575 open) and 51,979 tibial fractures (1339 open). Surgical treatment was done in 2.6% of closed and 37.5% of open forearm fractures and 7.9% of closed and 60.5% of open tibial fractures. A national estimated total of 3,312,807 closed and 46,569 open forearm fractures were included, 59,024 (1.8%) of which were treated surgically. A total of 719,374 closed and 26,144 open tibial fractures were identified; 52,506 (7.0%) were treated surgically. Multivariable regression revealed that race and/or insurance status were independent predictors for the lower likelihood of surgery in 3 of 4 groups: Black patients were 43% and 35% less likely to have surgery after closed and open forearm fractures, respectively, and patients with Medicaid were less often treated surgically for open tibial fractures in state (17%) and nationwide (20%) databases.

Conclusions: Disparities in pediatric forearm and tibial fracture care persist, especially for Black patients and those with Medicaid; identification of influencing factors and interventions to address them are important in improving equality and value of care.

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Conflict of interest statement

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Landau, Oladeji, and Dr. Hosseinzadeh.

References

    1. Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD: Variations in the use of internal fixation for distal radial fracture in the United States Medicare population. J Bone Joint Surg Am 2011;93:2154-2162. - PMC - PubMed
    1. Driesman A, Fisher N, Konda SR, Pean CA, Leucht P, Egol KA: Racial disparities in outcomes of operatively treated lower extremity fractures. Arch Orthop Trauma Surg 2017;137:1335-1340. - PubMed
    1. Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S: Racial and socioeconomic disparities in hip fracture care. J Bone Joint Surg Am 2016;98:858-865. - PMC - PubMed
    1. Dy CJ, Lyman S, Do HT, Fabricant PD, Marx RG, Green DW: Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures. J Pediatr Orthop 2014;34:548-551. - PMC - PubMed
    1. Iobst C, King W, Baitner A, Tidwell M, Swirsky S, Skaggs DL: Access to care for children with fractures. J Pediatr Orthop 2010;30:244-247. - PubMed

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