Health Equity Research in Orthopaedic Surgery: A Systematic Review and Needs Assessment.

Background: The aim of health equity research was to initially identify inequities and ultimately eliminate them. Little is known about the content, quality, and impact of health equity research in the orthopaedic literature. Therefore, the purpose of this study was to characterize the state of health equity research in orthopaedic surgery, with attention to temporal and specialty trends, research methodology, and intervention development.

Methods: The Clarivate Web of Science platform was queried for English-language publications from January 1, 2013, to December 31, 2022. Book chapters, meeting abstracts, proceeding papers, retracted publications, and non-English papers were excluded. Articles were filtered and then reviewed individually. Bibliometric data were noted, including publication year, open access, number of citations, and journal impact factor. We also collected information on clinical specialty, study design, community engagement, whether an intervention was designed or tested, and associated funding sources. Descriptive statistics were then calculated.

Results: The initial search yielded 7,248 total articles, 855 of which were included. The majority (552/855, 64.6%) were published between 2019 and 2022, with 205 (24.0%) in 2022 alone. Arthroplasty was the most represented subspecialty, with 370 articles (43.3%). Seven hundred eighty-four articles (91.7%) were observational or experimental research studies. Of these, 73.1% had a retrospective design. Only one study (0.1%) used qualitative methods. Thirty-six articles (4.2%) focused on interventions. However, only 8 (0.9%) evaluated original interventions, while the majority of the others retrospectively analyzed the impact of the Patient Protection and Affordable Care Act, Medicaid expansion, or bundled payments. Eighteen publications (2.1%) were directly supported by National Institutes of Health funding.

Conclusion: There was a sharp increase in the number of orthopaedic publications on disparities, especially since 2019. Most are retrospective and identify or describe a disparity rather than investigate an intervention. There was a near-complete lack of qualitative methodology, community engagement, or federal funding. More institutional and financial support for this work is critical, as is the adaptation of new methodologies and community involvement.