Effect of Race/ethnicity, Insurance Status, and Area Deprivation on Hip Fracture Outcomes Among Older Adults in the United States

Lee, Chiyoung; McConnell, Eleanor S.; Wei, Sijia; Xue, Tingzhong; Tsumura, Hideyo; Pan, Wei

doi:10.1177/10547738211061216

Cited by 5 publications

(2 citation statements)

References 41 publications

(53 reference statements)

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“…Specifically, Medicaid and Medicare insurance were associated with decreased odds of both NA and PNB receipt, and uninsured status was associated with decreased odds of NA receipt 19. These results align with previous literature across medical disciplines that have suggested significant socioeconomical and racial differences in healthcare outcomes in breast cancer surgery,31 32 trauma,33 hip fracture surgery,34 and access to genetic counseling in high-risk patients 35…”

Section: Discussionsupporting

confidence: 88%

Association of patient characteristics with the receipt of regional anesthesia

Beletsky

Currie

Shen

et al. 2023

Reg Anesth Pain Med

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BackgroundRegional anesthesia (RA) may improve patient-related outcomes, including decreased operative complications, shortened recovery times, and lower hospital readmission rates. More analyses are needed using a diverse set of databases to examine characteristics associated with the receipt of RA.MethodsA national hospital database was queried for patients 18 years or older who underwent total shoulder arthroplasty (TSA), total knee arthroplasty (TKA), anterior cruciate ligament reconstruction (ACLR), carpal tunnel release, ankle open reduction, and internal fixation and arteriovenous fistula creation between January 2016 and June 2021. Regional techniques included neuraxial anesthesia and various upper and lower extremity peripheral nerve blocks to create a binary variable of RA receipt. Univariate statistics were used to compare characteristics associated based on RA receipt and multivariable regression identified factors associated with RA receipt.ResultsA total of 51 776 patients were included in the analysis, of which 2111 (4.1%) received RA. Factors associated with decreased odds of RA receipt included black race (vs white race; OR 0.73, 95% CI 0.62 to 0.86), other non-white race (vs white race; OR 0.71, 95% CI 0.61 to 0.86), American Society of Anesthesiologists (ASA) class (vs ASA 1; OR 0.85, 95% CI 0.79 to 0.93), and Medicaid insurance (vs private insurance; OR 0.65, 95% CI 0.51 to 0.82) (all p<0.05). When compared with TKA, ACLR (OR 0.67, 95% CI 0.53 to 0.84), ankle open reduction and internal fixation (OR 0.68, 95% CI 0.58 to 0.81), and carpal tunnel release (OR 0.68, 95% CI 0.59 to 0.78) demonstrated lower odds of RA receipt, whereas TSA (OR 1.31, 95% CI 1.08 to 1.58) demonstrated higher odds of RA receipt (all p<0.05).ConclusionRA use varies with respect to race, insurance status, and type of surgery.

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Section: Discussionsupporting

confidence: 88%

Association of patient characteristics with the receipt of regional anesthesia

Beletsky

Currie

Shen

et al. 2023

Reg Anesth Pain Med

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“…Two authors performed the cohort selection independently and discussed and resolved any discrepancies by going through the patients' charts. Further details of cohort selection in this study are shown in Figure 1 and previously reported (Lee et al, 2022).…”

Section: Cohort Selectionmentioning

confidence: 99%

Comorbidity Patterns in Older Patients Undergoing Hip Fracture Surgery: A Comorbidity Network Analysis Study

Lee,

Wei,

McConnell

et al. 2023

Clin Nurs Res

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Comorbidity network analysis (CNA) is a technique in which mathematical graphs encode correlations (edges) among diseases (nodes) inferred from the disease co-occurrence data of a patient group. The present study applied this network-based approach to identifying comorbidity patterns in older patients undergoing hip fracture surgery. This was a retrospective observational cohort study using electronic health records (EHR). EHR data were extracted from the one University Health System in the southeast United States. The cohort included patients aged 65 and above who had a first-time low-energy traumatic hip fracture treated surgically between October 1, 2015 and December 31, 2018 ( n = 1,171). Comorbidity includes 17 diagnoses classified by the Charlson Comorbidity Index. The CNA investigated the comorbid associations among 17 diagnoses. The association strength was quantified using the observed-to-expected ratio (OER). Several network centrality measures were used to examine the importance of nodes, namely degree, strength, closeness, and betweenness centrality. A cluster detection algorithm was employed to determine specific clusters of comorbidities. Twelve diseases were significantly interconnected in the network (OER > 1, p-value < .05). The most robust associations were between metastatic carcinoma and mild liver disease, myocardial infarction and congestive heart failure, and hemi/paraplegia and cerebrovascular disease (OER > 2.5). Cerebrovascular disease, congestive heart failure, and myocardial infarction were identified as the central diseases that co-occurred with numerous other diseases. Two distinct clusters were noted, and the largest cluster comprised 10 diseases, primarily encompassing cardiometabolic and cognitive disorders. The results highlight specific patient comorbidities that could be used to guide clinical assessment, management, and targeted interventions that improve hip fracture outcomes in this patient group.

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