⚡ Quick Summary
This study investigates racial disparities in the utilization and clinical outcomes of hip arthroscopy, revealing that racial and ethnic minority patients undergo the procedure at a significantly lower rate compared to White patients. Despite these disparities, the study found negligible differences in clinical outcomes between the groups.
🔍 Key Details
- 📊 Dataset: 9,745 patients undergoing hip arthroscopy from 2011 to 2017
- 🧩 Patient Demographics: 11.1% identified as racial and ethnic minorities
- ⚙️ Methodology: Utilized targeted maximum likelihood estimation (TMLE) and machine learning algorithms
- 🏆 Key Findings: White patients had a hip arthroscopy incidence rate 5.68 times higher than minority patients
🔑 Key Takeaways
- 📉 Disparity in Utilization: White patients underwent hip arthroscopy at a rate 5.68 times higher than racial and ethnic minorities.
- 📈 Annual Growth Rates: Incidence rates grew at 1.11 for White patients versus 1.03 for minorities (P < .001).
- 💰 Higher Costs: Racial and ethnic minority patients incurred significantly higher costs per surgical encounter (P < .001).
- 🏥 Emergency Visits: Minority patients were more likely to visit the emergency department within 90 days post-surgery (P = .049).
- 🔍 Insurance and Income Factors: Higher likelihood of ED visits among minorities was linked to Medicare insurance and low-income neighborhoods.
- 🔄 Reoperation Rates: No significant differences in reoperation rates at 2-year follow-up (P = .53).
📚 Background
The field of arthroscopic surgery has advanced significantly over the past three decades, particularly in the treatment of femoroacetabular pathology. However, a concerning trend has emerged: a reduced utilization of these procedures among racial and ethnic minority populations. Understanding these disparities is crucial for improving healthcare equity and ensuring that all patients receive appropriate surgical interventions.
🗒️ Study
This cross-sectional study analyzed data from the State Ambulatory Surgery and Services Database and the State Emergency Department Database of New York, focusing on patients who underwent hip arthroscopy between 2011 and 2017. The researchers aimed to identify differences in case incidence rates, outcomes, and complications between White patients and those from racial and ethnic minority backgrounds.
📈 Results
The analysis revealed that out of 9,745 patients, only 1,081 (11.1%) were from minority backgrounds. The incidence rate of hip arthroscopy for White patients was found to be 5.68 times higher than that of racial and ethnic minorities. Furthermore, while both groups experienced similar reoperation rates, minority patients faced higher costs and were more likely to require emergency care shortly after surgery.
🌍 Impact and Implications
The findings of this study highlight significant healthcare disparities that warrant attention from policymakers and healthcare providers. By addressing the barriers that prevent racial and ethnic minorities from accessing hip arthroscopy, we can work towards a more equitable healthcare system. This research underscores the importance of utilizing advanced methodologies, such as machine learning, to uncover hidden trends and inform future interventions.
🔮 Conclusion
This study sheds light on the critical issue of racial disparities in the utilization of hip arthroscopy. Despite similar clinical outcomes, the lower incidence rates and higher costs for minority patients indicate a need for targeted efforts to improve access to care. As we move forward, it is essential to continue exploring these disparities and implement strategies that promote equity in surgical interventions.
💬 Your comments
What are your thoughts on the findings of this study regarding racial disparities in hip arthroscopy? We invite you to share your insights and engage in a discussion! 💬 Leave your comments below or connect with us on social media:
Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning.
Abstract
BACKGROUND: Arthroscopic diagnosis and treatment of femoroacetabular pathology has experienced significant growth in the last 30 years; nevertheless, reduced utilization of orthopaedic procedures has been observed among the underrepresented population.
PURPOSE/HYPOTHESIS: The purpose of this study was to examine racial differences in case incidence rates, outcomes, and complications in patients undergoing hip arthroscopy. It was hypothesized that racial and ethnic minority patients would undergo hip arthroscopy at a decreased rate compared with their White counterparts but that there would be no differences in clinical outcomes.
STUDY DESIGN: Cross-sectional study.
METHODS: The State Ambulatory Surgery and Services Database and the State Emergency Department Database of New York were queried for patients undergoing hip arthroscopy between 2011 and 2017. Patients were stratified into White and racial and ethnic minority races, and intergroup comparisons were performed for utilization over time, total charges billed per encounter, 90-day emergency department (ED) visits, and revision hip arthroscopy. Temporal trends in the utilization of hip arthroscopy were identified, and racial differences in secondary outcomes were analyzed with a semiparametric method known as targeted maximum likelihood estimation (TMLE) backed by a library of machine learning algorithms.
RESULTS: A total of 9745 patients underwent hip arthroscopy during the study period, with 1081 patients of minority race (11.1%). White patients underwent hip arthroscopy at 5.68 (95% CI, 4.98-6.48) times the incidence rate of racial and ethnic minority patients; these incidence rates grew annually at a ratio of 1.11 in White patients compared with 1.03 in racial and ethnic minority patients (P < .001). Based on the TMLE, racial and ethnic minority patients were significantly more likely to incur higher costs (P < .001) and visit the ED within 90 days (P = .049) but had negligible differences in reoperation rates at a 2-year follow-up (P = .53). Subgroup analysis identified that higher likelihood for 90-day ED admissions among racial and ethnic minority patients compared with White patients was associated with Medicare insurance (P = .002), median income in the lowest quartile (P = .012), and residence in low-income neighborhoods (P = .006).
CONCLUSION: Irrespective of insurance status, racial and ethnic minority patients undergo hip arthroscopy at a lower incidence and incur higher costs per surgical encounter.
Author: [‘Lu Y’, ‘Alder KD’, ‘Marigi EM’, ‘Mickley JP’, ‘Dancy M’, ‘Hevesi M’, ‘Levy BA’, ‘Krych AJ’, ‘Okoroha KR’]
Journal: Orthop J Sports Med
Citation: Lu Y, et al. Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning. Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning. 2024; 12:23259671241257507. doi: 10.1177/23259671241257507