Neighborhood socioeconomic disadvantages influence outcomes following rotator cuff repair in the non-Medicaid population

Abstract

BackgroundPrior investigations have utilized various surrogate markers of socioeconomic status to assess how healthcare disparities impact outcomes after rotator cuff repair (RCR). When taken as individual markers, these factors have inconsistent associations. Medicaid insurance status is an accessible marker that has recently been correlated with less optimal outcomes after RCR. Socioeconomic disparities exist within the non-Medicaid population as well and are arguably more difficult to characterize. The Area Deprivation Index (ADI) uses seventeen socioeconomic variables to establish a spectrum of neighborhood healthcare disparity. The purpose of this study was to determine the influence of neighborhood socioeconomic disadvantages, quantified by ADI, on 2-year patient reported outcome scores following RCR in the non-Medicaid population. MethodsA retrospective review of patients who underwent RCR from 2015-2020 was performed. All procedures were performed by a group of seven surgeons at a large academic center. Patient demographics and comorbidities were collected from charts. Rotator cuff tear size was assessed from arthroscopic pictures. ADI scores were calculated based on patients’ home addresses using the Neighborhood Atlas tool. The primary outcome measure was American Shoulder and Elbow Surgeons (ASES) score with minimum follow-up of two years. A linear regression analysis with covariate control for age and patient comorbidities was performed. ResultsThere were 287 patients with a mean age of 60.11 years. The linear regression model between ADI and two-year ASES score was significant (p = .02). When controlling for both age and patient comorbidities, every 0.9-point reduction in ADI resulted in a 1-point increase in the ASES score (P = 0.03). Patients with an ADI of 8, 9, or 10 had lower mean two-year ASES scores than those with an ADI of 1 (87.08 vs 93.19, p = .04), but both groups had similar change from preoperative ASES score (40.17 vs 32.88, p =.12). The change in ASES score at two-years in our study surpassed all established MCID values irrespective of ADI. ConclusionPatients with greater levels of disparity in their home neighborhoods have worse final ASES scores at two years, but patients significantly improve from their preoperative state regardless of social disadvantages. This is the first study to the authors’ knowledge that examines ADI and outcomes following RCR. Providers should be aware that patients with higher ADI scores may have inferior preoperative shoulder function. The results of this study support the utilization of primary rotator cuff repair in applicable tears regardless of socioeconomic status.