Race, Socioeconomics Matter in Hip Fracture Care

Researchers at Hospital for Special Surgery (HSS) have found that people in certain racial and socioeconomic groups are at a disadvantage when it comes to care they receive after fracturing a hip. Investigators based their findings on information available for nearly 200, 000 patients in a New York state database.

“The study found that black patients, Medicaid patients, and patients from impoverished communities are at increased risk for poor outcomes, ” said Michael Parks, M.D., a study author and orthopedic surgeon at Hospital for Special Surgery, in the March 26, 2015 news release.

Individuals who had surgery for a broken hip in New York State from 1998 to 2010 were identified. Factors assessed included the need for a subsequent procedure within one year; hospital readmissions within 90 days of surgery; complications within 90 days; and in-hospital mortality within one year of discharge following hip fracture surgery.

After adjusting for patient and community characteristics, investigators found that African American patients had a 55% increased risk for delayed surgery. They were 18% more likely to be readmitted to the hospital within 90 days and had a 12% higher risk of dying within one year compared to Caucasian patients.

Compared to Medicare patients, Medicaid patients had a 15% increased risk for delayed surgery. Patients who had private insurance were 21% less likely to experience delayed surgery, 23% less likely to be readmitted to the hospital and 20% less likely to experience complications, compared to Medicare patients. Those with private insurance were 19% less likely to die within one year.

Dr. Parks told OTW, “Future study of disparities in hip fracture care is needed. In order to better understand the reasons for this differential in care, further understanding of the relationship of patient and community characteristics and outcomes is needed.”

“Our study shows that high levels of household poverty and lower levels of education were associated with poor outcomes and higher rates of reoperation. Future testing and evaluation of targeted interventions to address factors leading to delays in care and medical comorbidities in poor and minority populations may help us decrease or eliminate the surgical delays and poor outcomes we saw in our study. Specifically, we need to understand patient factors to help individuals with health literacy and to improve their ability to participate in their care.”

“What interventions are effective in populations with low education and low health literacy to better empower patients to make decisions? Is there quality care available in census locations with increased poverty and lower education? We need to understand community characteristics that may limit access to quality care available.”