Race and Socioeconomic Status are Associated with Inferior Patient Reported Outcome Measures Following Rotator Cuff Repair

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PURPOSE: To investigate the impact Social Determinants of Health (SDOH) have on National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) scores and postoperative health care utilization in rotator cuff repair (RCR) patients.

METHODS: All patients who underwent RCR surgery by 3 shoulder and/or sports medicine fellowship-trained orthopedic surgeons between July 2017 and January 2020 were included. The electronic medical record (EMR) was used to identify SDOH for each patient. PROMIS CAT measures of Upper Extremity function ("PROMIS UE"), Pain Interference ("PROMIS PI"), and Depression ("PROMIS D") were completed preoperatively and postoperatively (6-months and 1-year). Postoperative health care utilization (clinical visits, virtual encounters, imaging encounters and physical therapy visits) were recorded as well. Univariate associations, multiple linear regressions, and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH.

RESULTS: Three hundred thirty-eight RCR patients were included. Patients who were Black, in lower median household income (MHI) quartiles, had public insurance, and female reported lower PROMIS scores compared to their counterparts. Smokers and white patients attended fewer postoperative office visits while Black patients attended greater physical therapy (PT) and non-visit encounters compared to their respective counterparts.

CONCLUSION: Black race and lower socioeconomic status are associated with worse function and pain outcomes post-RCR compared to whites. Similarly, Black race and positive smoking status are associated with differential utilization of health care following RCR. Further attention may be required for these patients to address healthcare disparities.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.

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ePub ahead of print