rotator cuff; insurance; orthpaedics


Musculoskeletal Diseases | Orthopedics


Background: The relationship of socioeconomic disparity in access to rotator cuff repair (RCR) has not been well studied. Socioeconomic, racial, and ethnic disparities in access to surgical management of rotator cuff tears have previously been described in patients with commercial insurance. This study is a population-level analysis which investigates racial and ethnic disparities in access to surgical rotator cuff repair across multiple health insurance statuses.

Purpose: (1) Is non-white race and ethnicity associated with lower rates of RCR? (2) Do these associations change throughout different insurance statuses?

Methods: We used the Healthcare Cost and Utilization Project (HCUP) database to identify patients who underwent elective RCR in Florida, Maryland, Iowa, and Wisconsin in 2016 and 2017. White and non-white patients who underwent RCR were compared by insurance status. To evaluate whether demographics of patients who underwent RCR reflected the general population, patients within the HCUP sample were compared to US census-level data for the same states and years, including a subgroup analysis by insurance status.

Results: There were 81,607 patients in the HCUP sample who underwent rotator cuff repair, of whom 81% were white and 19% were non-white. 55% had commercial insurance, 39% had Medicare insurance, and 5% had Medicaid insurance. Compared to census data, all races/ethnicities other than non-Hispanic white were underrepresented in the sample of patients who underwent rotator cuff repair (p

Conclusion: This analysis of disparities is the first large database study to examine the relationship between gender, race, insurance status, and elective RCR. Regardless of insurance status, patients who underwent elective RCR were more likely to be white and male when compared with the general population, suggesting a persistence of disparities.