Significant Racial and Socioeconomic Disparities Persist in Musculoskeletal Care Across the Country

A new study observed significant racial and socioeconomic disparities for nonemergent musculoskeletal conditions.

The study authors established two questions to be answered by the research:

  1. Are there identifiable nationwide sociodemographic disparities in the use of either office-based orthopaedic care or ED care for common, nonemergent musculoskeletal conditions?
  2. Is there a meaningful difference in expenditures associated with these same conditions when care is provided in the office rather than the ED?

The study was published in Clinical Orthopaedics and Related Research.

Data were obtained from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS). MEPS is administered by the Agency for Healthcare Research and Quality and tracks healthcare usage data. Office-based and emergency department care were compared among patients from different socioeconomic and demographic groups.

A total of 63,514 patients were included in the study. Just over half of patients (n=32,177) were aged between 35 and 64 years; 29% were older than 65 years. The majority of patients (n=37,031; 58%) were female. Eight condition categories were included for analysis: osteoarthritis (40%), joint derangement (0.5%), other joint conditions (43%), muscle or ligament conditions (6%), bone or cartilage conditions (8%), foot conditions (1%), fractures (7%), and sprains or strains (18%).

What Factors Affect Musculoskeletal Care?

When adjusting for factors including age, gender, region, insurance status, income, education level, and self-reported health status, outpatient musculoskeletal care use was significantly lower among the following groups: Hispanic (odds ratio [OR]=0.79; 95% confidence interval [CI], 0.72 to 0.86]; P<0.001), non-Hispanic black (OR=0.77; 95% CI, 0.70 to 0.84; P<0.001), lesser-educated (OR=0.72; 95% CI, 0.65 to 0.81; P<0.001), lower-income (OR=0.80; 95% CI, 0.73 to 0.88; P<0.001), and nonprivately-insured (OR=0.85; 95% CI, 0.79 to 0.91; P<0.001). Greater use of musculoskeletal care in the emergency department was observed in the following groups: public insurance (OR=1.30; 95% CI, 1.17 to 1.44; P<0.001), lower income (OR=1.53; 95% CI, 1.28 to 1.82; P<0.001), and lesser education (OR=1.35; 95% CI, 1.14 to 1.60; P=0.001).

“There are substantial sociodemographic disparities in the use of office-based orthopaedic care and [emergency department] care for common, nonemergent musculoskeletal conditions. Because of the lower expenditures associated with office-based orthopaedic care, orthopaedic surgeons should make a concerted effort to improve access to outpatient care for these populations,” the study authors summarized. “This may be achieved through collaboration with policymakers, greater initiatives to provide care specific to minority populations, and targeted efforts to improve healthcare literacy.”