Donghoon Lee, Henson Destine, Andres Perez, Maxwell C Detweiler, Douglas R Corsi, Adam J Lencer, Brian S Gibbs, Kevin B Freedman, Fotios P Tjoumakaris
{"title":"Workman's compensation as exclusion criteria in rotator cuff repair literature - are we inadvertently excluding race?","authors":"Donghoon Lee, Henson Destine, Andres Perez, Maxwell C Detweiler, Douglas R Corsi, Adam J Lencer, Brian S Gibbs, Kevin B Freedman, Fotios P Tjoumakaris","doi":"10.1080/00913847.2023.2267556","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Despite an equal willingness to participate in clinical trials, there is evidence that several minority populations are systematically under-represented in studies. One potential cause and frequently used exclusionary criterion in orthopedic trials is patients with active workman's compensation (WC) insurance claims. The purpose of this study is to determine demographic differences in patients undergoing arthroscopic rotator cuff repair with commercial and government insurance vs workers compensation claims.</p><p><strong>Methods: </strong>This was a retrospective review of patients who underwent primary arthroscopic rotator cuff repair at a single institution in the northeastern United States from 2018 to 2019. Patients undergoing revision cases were excluded. Chart review was used to extract demographic data such as age, gender, insurance, and reported race.</p><p><strong>Results: </strong>A total of 4553 patient records were reviewed and included. There were 742 WC patients and 3811 non-WC patients. Two hundred and forty-four patients did not report their race. Overall, WC patients differed from non-WC with respect to race (<i>P</i> < 0.001). One hundred and eleven (15.0%) of WC and 293 (7.7%) non-WC patients reported being 'Black' or 'African American' (<i>P</i> = 0.002). This compares to 368 (49.6%) WC and 2788 (73.2%) non-WC patients who reported 'White' (<i>P</i> < 0.001). About 16.8% of WC patients were identified as 'Hispanic or Latino,' compared to 5.2% of non-WC (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>African American and Hispanic/Latino patients are over-represented in workman's compensation patient populations relative to non-workman's compensation. Conversely, white patients are over-represented in non-WC patient populations, which serve as the basis for the majority of clinical study populations. Excluding workman's compensation patients from clinical trials may lead to an underrepresentation of African American and Hispanic/Latino patient populations in orthopedic clinical trials. In doing so, the generalizability of the results of rotator cuff repair clinical outcomes research to all races and ethnicities may be compromised.</p>","PeriodicalId":51268,"journal":{"name":"Physician and Sportsmedicine","volume":" ","pages":"355-359"},"PeriodicalIF":1.9000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physician and Sportsmedicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/00913847.2023.2267556","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/10/13 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Despite an equal willingness to participate in clinical trials, there is evidence that several minority populations are systematically under-represented in studies. One potential cause and frequently used exclusionary criterion in orthopedic trials is patients with active workman's compensation (WC) insurance claims. The purpose of this study is to determine demographic differences in patients undergoing arthroscopic rotator cuff repair with commercial and government insurance vs workers compensation claims.
Methods: This was a retrospective review of patients who underwent primary arthroscopic rotator cuff repair at a single institution in the northeastern United States from 2018 to 2019. Patients undergoing revision cases were excluded. Chart review was used to extract demographic data such as age, gender, insurance, and reported race.
Results: A total of 4553 patient records were reviewed and included. There were 742 WC patients and 3811 non-WC patients. Two hundred and forty-four patients did not report their race. Overall, WC patients differed from non-WC with respect to race (P < 0.001). One hundred and eleven (15.0%) of WC and 293 (7.7%) non-WC patients reported being 'Black' or 'African American' (P = 0.002). This compares to 368 (49.6%) WC and 2788 (73.2%) non-WC patients who reported 'White' (P < 0.001). About 16.8% of WC patients were identified as 'Hispanic or Latino,' compared to 5.2% of non-WC (P < 0.001).
Conclusion: African American and Hispanic/Latino patients are over-represented in workman's compensation patient populations relative to non-workman's compensation. Conversely, white patients are over-represented in non-WC patient populations, which serve as the basis for the majority of clinical study populations. Excluding workman's compensation patients from clinical trials may lead to an underrepresentation of African American and Hispanic/Latino patient populations in orthopedic clinical trials. In doing so, the generalizability of the results of rotator cuff repair clinical outcomes research to all races and ethnicities may be compromised.
目的：尽管参与临床试验的意愿相同，但有证据表明，一些少数群体在研究中的代表性系统性不足。骨科试验中经常使用的一个潜在原因和排除标准是患者有积极的工人赔偿（WC）保险索赔。本研究的目的是确定接受关节镜下肩袖修复的商业和政府保险患者与工人赔偿索赔患者的人口统计学差异。方法：这是对2018-2019年在美国东北部一家机构接受初级关节镜下肩袖修复的患者的回顾性回顾。接受翻修手术的患者被排除在外。图表审查用于提取人口统计数据，如年龄、性别、保险和报告的种族。结果：4553份患者记录被审查并纳入。共有742名WC患者和3811名非WC患者。244名患者未报告其种族。总的来说，WC患者与非WC患者在种族方面存在差异（P P = 0.002）。相比之下，368名（49.6%）WC患者和2788名（73.2%）非WC患者报告为“白人”（P P 结论：与非工人补偿相比，非裔美国人和西班牙裔/拉丁裔患者在工人补偿患者群体中的比例过高。相反，白人患者在非WC患者群体中的比例过高，这是大多数临床研究人群的基础。将工人补偿患者排除在临床试验之外可能会导致非裔美国人和西班牙裔/拉丁裔患者在骨科临床试验中的代表性不足。这样做，肩袖修复临床结果研究结果对所有种族和民族的可推广性可能会受到影响。
期刊介绍：
The Physician and Sportsmedicine is a peer-reviewed, clinically oriented publication for primary care physicians. We examine the latest drug discoveries to advance treatment and recovery, and take into account the medical aspects of exercise therapy for a given condition. We cover the latest primary care-focused treatments serving the needs of our active patient population, and assess the limits these treatments govern in stabilization and recovery.
The Physician and Sportsmedicine is a peer-to-peer method of communicating the latest research to aid primary care physicians’ advancement in methods of care and treatment. We routinely cover such topics as: managing chronic disease, surgical techniques in preventing and managing injuries, the latest advancements in treatments for helping patients lose weight, and related exercise and nutrition topics that can impact the patient during recovery and modification.
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