Highlights
- •The aim of this study was to examine the correlation between patient rurality, socioeconomic status, and outcomes after orthopedic trauma.
- •A nationally representative sample, representing over 1 million patients, was used to build population-weighted logistic regression models.
- •Rural patients with hip fracture were 32% more likely to die than urban patients with hip fracture (P < 0.001).
- •Patients with low income were 23% more likely to die than patients with high income (p = 0.002) in the urban polytrauma group.
- •Objective measures of disparity-sensitive healthcare are needed to ensure optimal care for all orthopedic trauma patients.
Abstract
Introduction
Healthcare disparities linked to patient rurality and socioeconomic status are known
to exist, but few studies have examined the effect of urban versus rural status on
outcomes after orthopedic trauma surgery. The aim of this study was to examine the
correlation between patient rurality, socioeconomic status, and outcomes after orthopedic
trauma.
Materials and methods
This is a retrospective cohort study of patients diagnosed with a hip or long bone
fracture between January 2016 and December 2017. Data were collected from the Nationwide
Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population.
Patients were stratified into 3 groups: isolated hip fracture, isolated long bone
fracture, and polytrauma. Bivariate analysis was completed using chi-squared tests
for categorical variables and t-tests for continuous variables. Multivariable analysis
was completed using population-weighted logistic regression models, based on a conceptual
model derived selection of covariates.
Results
We included 235,393 patients diagnosed with a hip or extremity fracture. These were
weighted to represent 1,176,965 patients nationally. In the hip fracture group, rural
patient status was associated with higher odds of mortality (OR 1.32, P < 0.001) but not complications (OR 0.95, P = 0.082). In the extremity fracture and polytrauma groups, rural patient status was
not associated with significantly higher odds of mortality or complications. In the
urban polytrauma group, zip code with below-median income was associated with increased
odds of mortality (OR 1.23, P = 0.002) but not complications. In the rural polytrauma group, zip code with below-median
income was not associated with significantly increased odds of mortality or complications.
In the hip fracture and extremity fracture groups, below-median income was not associated
with significantly higher odds of mortality.
Conclusion
We found that rural patients with hip fracture have higher mortality compared to urban
patients and that socioeconomic disparities in mortality after a polytrauma exist
in urban settings. These results speak to the ongoing need to develop objective measures
of disparity-sensitive healthcare and optimize trauma systems to better serve low-income
patients and patients in rural areas.
Keywords
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Article Info
Publication History
Published online: November 08, 2022
Accepted:
November 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
