In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically

Purpose The purpose of the current study was to evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear. Methods From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)—9th Revision—Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD-9-CM and ICD-10-CM codes were used to identify the initial diagnosis for each patient. Current Procedural Terminology codes were used to identify subsequent rotator cuff surgery. The procedures identified were linked with the initial diagnosis, and patients were noted as either having or not having rotator cuff surgery. Logistic regression analysis was performed for variables including age, sex, race, Social Deprivation Index (SDI), Charlson Comorbidity Index, and primary insurance type to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of rotator cuff injury. Results Of the 67,584 rotator cuff patients included in the analysis, 19,770 (29.3%) of the patients underwent surgical intervention. From the logistic regression, females relative to males (odds ratio [OR] = 0.798, P < .0001), increased SDI (OR = 0.994, p < .0001), African American compared with White race (OR = 0.694, P < .0001), Asian compared with White (OR = 0.832, P < .0001), Hispanic compared with White (OR = 0.693, P < .0001), other race (OR = 0.58, P < .0001), those with Medicare (OR = 0.601, P < .0001) or Medicaid (OR = 0.614, P < .0001) relative to private insurance, and self-pay relative to private insurance (OR = 0.727, P < .0001) were all associated with decreased odds of undergoing rotator cuff surgery. Older patients (OR = 1.012, P < .0001) and Workers’ Compensation relative to private insurance (OR = 1.664, P < .0001) had increased odds of undergoing surgery. Conclusions The results of the current study identified disparities in the likelihood of undergoing rotator cuff repair after a diagnosis of a rotator cuff tear based on patient demographic and socioeconomic factors. Individuals with higher SDI; African American, Asian, Hispanic, or other non-White races; and those with Medicare, Medicaid, or self-pay insurance had decreased odds of surgery, whereas older age and Workers’ Compensation insurance were associated with increased odds of undergoing surgery. Level of Evidence Level IV, retrospective case series