Racial And Ethnic Disparities In Operative Management Of Carpal Tunnel Syndrome In A National Single-payer System
Trista M. Benitez, MPH, BA, Rachel C. Hooper, MD, Erika D. Sears, MD, MS.
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, Ann Arbor, MI, USA.
PURPOSE: Despite evidence to support carpal tunnel release (CTR) for persistent carpal tunnel syndrome (CTS), civilian studies have found substantial racial and ethnic disparities. The Veterans Health Administration (VHA) is the largest U.S. integrated healthcare system and prioritizes access to care, thus providing a unique setting to assess the degree of disparities in receiving surgical consultation or CTR.
METHODS: We conducted a retrospective study of VHA patients evaluated for CTS using the VHA Corporate Data Warehouse (2010-2016). Patients were followed for two years or until CTR. We studied the association of race and ethnicity with receipt of surgical consultation and CTR using mixed-effects logistic regression. We nested four models to assess the impact of demographic, clinical, structural, and care process factors to the relationship of race and ethnicity to surgical consultation and CTR.
RESULTS: Of 165,976 patients, approximately 25.8% received surgical consultation and 11.9% underwent CTR. In the full model including demographic, clinical, structural, and process-related factors, Black, Asian, and Hispanic patients were less likely to receive surgical consultation (OR:0.84, 95%CI:0.81-0.87 Blacks; OR:0.86, 95%CI:0.75-0.98 Asians; OR:0.93, 95%CI:0.88-0.98 Hispanics). Similarly, compared to non-Hispanic white patients, racial and ethnic minority groups were less likely to undergo CTR (OR:0.58, 95%CI:0.55-0.61 Blacks; OR:0.65, 95%CI:0.0.53-0.80 Asians; OR:0.84, 95%CI:0.78-91 Hispanics). The direction and significance of these associations was maintained in all models.
CONCLUSION: Racial and ethnic minority patients were less likely to receive surgical consultation and CTR after adjusting for multilevel factors. Our modelsí findings demonstrate barriers to surgery exist, particularly for Blacks following surgical consultation.
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