Effect of Racial, Ethnic and Linguistic Disparities on the Treatment of End-Stage Ankle Osteoarthritis

CATEGORY: Ankle Arthritis; Trauma INTRODUCTION/PURPOSE: Social and demographic determinants of health including gender, race, ethnicity and language, have been shown to impact treatment pathways across medical specialties. Very little such research, however, has focused explicitly on orthopaedic foot and ankle patients. Given the debilitating health implications of ankle arthritis, this study aimed to investigate the effect of demographic and social factors on the treatment pathways and outcomes of patients presenting to orthopaedic foot and ankle surgeons with end-stage ankle arthritis. METHODS: In this retrospective, cross-sectional study, ICD 9/10 codes were used to identify 3,219 adult patients presenting to seven academic and community hospitals with ankle arthritis between 2011-2021. These patients were screened for end-stage ankle arthritis (Grade 3 or 4 on Kellgren-Lawrence Classification) and 509 patients were included in the final sample. For the primary variables of interest, patients were grouped by race (White/ Non-white), ethnicity (Hispanic/ Non-Hispanic), and primary spoken language (English/ non-English). Other demographic data included sex, age, body mass index, tobacco use, and insurance profile. The type of treatment (operative or nonoperative), length of postoperative admission, postoperative complication rates, and reoperation rates were compared between the groups using Chi square tests. Linear regression models were used to determine if the primary explanatory variables were among the factors affecting the time between initial consultation and surgical treatment, and duration of hospital stay. P<0.05 was considered statistically significant where applicable. RESULTS: Among the patients receiving treatment for end-stage ankle arthritis at our hospital system, 447 (87.82%) were White, 480 (94.3%) were non-Hispanic, and English was the most primary language among 482 (94.7%) patients. The difference in the proportion receiving nonoperative treatment between Whites and Non-whites (53.91% vs. 58.06%), Non-Hispanics and Hispanics (54.58% vs. 51.72%), and English and non-English speakers (54.56% vs. 51.85%) was not significant (p>0.05). Linear regression revealed that, among the explanatory variables, Hispanic ethnicity (Unstandardised coefficient=18.017; p=0.021), and history of former or no tobacco use (Unstandardised coefficient=9.156; p=0.021) significantly predicted the time gap between the diagnosis of end-stage ankle arthritis and surgical treatment. Regression models also showed that primary language being non-English and septic arthitis as a predisposing cause of arthitis significantly predicted hospital stay duration (Unstandardised coefficient= 3.409, 13.228 respectively, p= 0.010, <0.001 respectively). Race, ethnicity, and language had no significant association with post-operative complications and re-operation rates. CONCLUSION: This study demonstrated that race and ethnicity did not impact whether patients presenting with end-stage ankle arthritis were preferentially treated operatively or nonoperatively by orthopaedic foot and ankle surgeons at our institutions. However, non-English speaking patients were more likely to have lengthened hospital stays, and Hispanic patients had a longer time lapse between diagnostic consultation of end-stage osteoarthritis and operative treatment, underscoring that barriers to care still exist. Additional research is necessary to elucidate the manner in which demographics and social determinants of health impact the care of foot and ankle patients.