Social and Demographic Health Disparities in Shoulder and Elbow Surgery.

BACKGROUND: Racial and ethnic health disparities are important factors that contribute to outcomes in orthopedic surgery. With the increasing rates of common shoulder surgeries being performed, understanding all factors that contribute to patient outcomes is essential. There are several key socioeconomic and demographic factors, including insurance status, ethnicity, and Race, which have been implicated to impact both access to high-quality shoulder and elbow care and outcomes following shoulder and elbow surgery. In this review article, we seek to highlight the literature pertaining to social and demographic disparities in shoulder and elbow surgery for the purpose of providing policy makers and clinicians key information to optimize the equitable delivery of high-quality medical care to patients of all socioeconomic backgrounds. METHODS: A literature review of PubMed was conducted using several keywords with defined inclusion and exclusion criteria. RESULTS: A total of 22 articles were included across shoulder arthroplasty, rotator cuff repair, shoulder instability, and elbow arthroplasty. Multiple disparities were identified in the literature across Race, ethnicity, insurance status, and social determinants of health. CONCLUSIONS: Our search of the literature demonstrated significant disparities in shoulder and elbow surgeries, showing that racial, ethnic, and socioeconomic factors adversely affect patient outcomes due to decreased access quality care. To improve equity, recommendations include shifting care to high-volume and outpatient centers and increasing geographical diversity and access to surgical and rehabilitative care.