Public Insurance and Language Preferences Are Associated With a Longer Time to Surgery for Distal Radius Fractures.

Abstract

Introduction: Insurance type can result in disparities in access to specialist orthopaedic care. Here, we sought to quantify how insurance type affects time to surgery in patients with a distal radius fracture that needs surgical treatment.

Methods: A retrospective cohort study of patients ≥18 years with surgically managed, closed distal radius fractures was conducted. We measured the time from injury to surgery, the time from injury to clinic visit, and the time from clinic visit to surgery. Data were analyzed using linear regression models.

Results: We included 131 patients (69.0%) with private insurance and 56 patients (29.5%) with public insurance. The mean time from injury to surgery for the entire cohort was 12.4 ± 0.6 days. Private insurance patients had an average time from injury to surgery of 11.0 ± 0.5 days; public insurance patients had an average of 16.2 ± 1.3 days (P < 0.001). The increased time from injury to surgery for publicly insured patients was due to a 4.3-day longer (P < 0.001) time from injury to clinic visit; the time from clinic visit to surgery was similar (0.9 days, P = 0.216). In a stratified analysis, age was an effect modifier of the relationship between insurance type and time to surgery, with greater delays for younger patients. Preferred language other than English was associated with a 5.4 day longer time to surgery (P = 0.022) in a multivariate model.

Discussion: In patients with surgically treated distal radius fractures, public insurance was associated with a longer time to surgery, with such effect more pronounced for younger patients. Patients who spoke a language other than English also experienced greater delays. These findings warrant system-level efforts to address inequitable delays in care.