(110) Disparity Among Racial Groups for Humeral Fracture Treatments in a Medicaid Database

Publication Number: 441

Background: Racial disparities in elective care are documented but are less known in urgent care.

Objectives: Our study compared patient demographics, diagnoses, and healthcare utilization in humeral fractures among racial groups.

Methods: Patients from the IBM® MarketScan® Medicaid database with humeral fracture (date of first fracture diagnosis = index) from 10/1/2015 to 12/31/2020 were identified. Exclusion criteria included: concurrent fractures, amputation, other fractures pre-index. Variables included demographics, race (Black vs. White), comorbidities, fracture types (open vs. closed, Gustilo), and procedural characteristics (surgery type, implants). Outcomes included post-surgical treatment (medication use, reoperations) and complications (deep infection, nonunion, malunion, device breakage) up to 2-year post-index. For healthcare utilization analyses, surgically treated Black vs White cohorts were 1:1 propensity-score matched on age, gender, comorbidities, and fracture type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted.

Results: 7,679 humeral fracture patients were identified. Pre-matching, differences in fracture severity were observed. The Black cohort had a greater proportion of severe and comminuted fractures vs the White cohort (open fracture: 11.3% Black, 4.5% White; comminuted fractures: 15.7% Black vs 13.1% White). After matching, 674 Black vs 674 White patients were analyzed. Both groups had similar age (mean: 30.3, standard deviation (SD) 24.2), and fracture types (47% shaft fracture, 87.1% displaced, 32% comminuted). One- and 2-year reoperation rates reached 17.8% (95% confidence interval (CI): 15.2%-20.3%) and 21.1% (95%CI: 18.2%-24.1%), respectively, and were not different between Black and White cohorts. However, White patients were more likely to be reoperated (HR 1.56 (95%CI: 1.19-2.06, p < 0.001) vs Black patients. Amongst patients with severe complications, White patients were more likely to undergo reoperation (HR: 1.68 (95%CI: 1.11-2.57, p = 0.013). The 90-day prescription use was greater for White vs Black patients for benzodiazepines (4.8% Black vs 12.3% White, p < 0.0001), antidepressants (13.6% Black vs 18.5% White, p = 0.03), antibiotics (26.0% Black vs 33.3% White, p = 0.011) and mild/moderate opioids (72.6% Black vs 78.6% White, p = 0.027). There was no significant difference in strong opioid use (3.6% Black vs 4.1% White, p = 0.683).

Conclusions: Black patients were younger with more severe trauma vs White patients. Black and White humeral repair outcomes were comparable, but the Black patients' treatments, such as reoperation and medication, differed from the White patients.