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. 2023 Mar;7(2):252-256.
doi: 10.1016/j.jseint.2022.10.014. Epub 2022 Nov 12.

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

Avant-garde Health and Codman Shoulder Society Value Based Care Group; Matthew J Best  1 , Catherine J Fedorka  2 , Robert M Belniak  3 , Derek A Haas  4 , Xiaoran Zhang  4 , April D Armstrong  5 , Joseph A Abboud  6 , Andrew Jawa  7   8 , Evan A O'Donnell  9 , Jason E Simon  10 , Eric R Wagner  11 , Momin Malik  4 , Michael B Gottschalk  11 , Adam Z Khan  12 , Gary F Updegrove  5 , Eric C Makhni  13 , Jon J P Warner  9 , Uma Srikumaran  1
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The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States

Avant-garde Health and Codman Shoulder Society Value Based Care Group et al. JSES Int. 2023 Mar.

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.

Keywords: COVID-19; Coronavirus pandemic; Racial disparities; Shoulder; TSA; Total shoulder arthroplasty.

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