Introduction
Health disparities widely refer to underperformance in healthcare access, quality, and the cost-effectiveness of treatment modalities. Such shortcomings often result in poor therapeutic outcomes that affect an individual’s life quality, draining any country’s national resources spent on developing the healthcare system. Healthcare disparity is a global concern, even in well-developed countries like the United States.
The recent COVID-19 pandemic has illuminated these hidden healthcare pitfalls and brought them to the spotlight. Socioeconomic status, racial and ethnic diversity, education levels, sexual identification, gender orientation, and geographic variations significantly influence the prevalence of health disparities.
The orthopedic fraternity is not immunized against such inequalities, and healthcare disparities exist in various clinical aspects of orthopedic interventions. This article discusses some of the important clinical health disparity concepts in orthopedics. Understanding such issues of equity and bias would help initiate promising interventions and eradicate the existing differences that enhance orthopedic therapeutic outcomes.
What Does Health Disparity Mean?
CDC (Centers for Disease Control and Prevention) defines health disparities as avoidable differences associated with disease burden, injuries, violence, or available opportunities to reach optimal and absolute health which are widely endured by populations with social disadvantages.
Health disparities refer to inequities seen in healthcare quality and therapeutic outcomes often experienced by people based on racial, social, economic, ethnic, environmental, and geographic characteristics. These differences persist globally, almost across all nations. It is important to detect these barriers to healthcare and individual well-being and facilitate implementations to overcome such hindrances.
The common social determinants that contribute to health disparities are as follows -
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Inaccessibility to healthcare units.
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Providing poor healthcare quality.
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Community factors such as inadequate or lack of access to healthy and nutritious foods and poverty.
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Environmental and lifestyle conditions like poor air quality or work-life imbalance.
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Language barriers due to migration or travel.
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Health-affecting behaviors such as smoking, alcohol, and drug abuse.
Health disparities are measurable inequities and differences in healthcare access and associated outcomes between dominant or socially advantaged groups and less dominant or socially disadvantaged (marginalized) populations. These health disparities are often assessed or measured by comparing health indicators between the more advantaged (dominant) groups and the less advantaged (less dominant) groups.
What Are the Common Health Disparities Seen in Orthopedic Interventions?
In recent years, various scientific studies have documented that disparities in treatment interventions for musculoskeletal disorders have led to considerable disability among individuals.
Some of the proven health disparities existing in orthopedic management are listed below -
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Marked disparities are reported in access to orthopedic care and therapeutic outcomes related to fracture treatments, arthroplasty (hip and knee), and pain management.
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Osteoarthritis is considered a prominent cause of arthritis-associated disability. Various clinical studies prove that the disabling consequences of arthritis, physical limitations in activity and work, and the prevalence of extreme pain are seen disproportionately in certain racial and ethnic groups.
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Using the National Inpatient Sample (NIS) dataset, patients with calcaneal fractures were analyzed. This analysis showed that socio-demographic factors such as elderly population, female gender, insurance status, and estimated low income significantly reduced utilization of orthopedic interventions like internal fixation and open reduction.
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The number of orthopedic surgical treatments is lower in limited-resource healthcare settings, small hospital units, and non-medical education facilities.
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Statistical studies show that the socially advantaged group receives more joint arthroplasty as a treatment intervention for advanced hip or knee osteoarthritis. Economic access to income, health insurance, and assets are the common causes of such disparities.
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Functional levels of therapeutic outcomes such as physical functioning and range of motion are markedly reduced by medical comorbidities like diabetes, alcohol abuse, peripheral vascular disease, and other related clinical conditions.
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Healthcare KPI (Key Performance Indicators) or hospital metrics such as average hospital stay, treatment costs, patient follow-up rate, and medical equipment usage are negative in disadvantaged groups when compared to the dominant population.
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Health literacy greatly influences patient-level preferences when opting for surgical interventions like total joint arthroplasty.
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Some studies have documented gender bias in receiving orthopedic surgeries, where women have a three-fold lesser chance of receiving knee arthroplasty when compared to men.
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Lack of accessibility due to geographic or residential segregation and limited transportation access reduces joint arthroplasty outcomes and rates.
What Are the Factors That Cause Health Disparities in Orthopedics?
Several studies and statistical research have been conducted to identify the potential factors that lead to health disparities in orthopedic management.
Some of them are listed below -
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Language barriers influence postoperative orthopedic interventions like understanding ideal nutrition, instructions for regular exercise, and weight management.
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Education, comprehension ability, and health literacy play a prime role in preventing delays in orthopedic care and influencing the choice of treatment plans.
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Psychological health is another contributing factor to health disparity, as symptoms like emotional distress would negatively influence orthopedic treatment and clinical prognosis.
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Physical health factors such as obesity, diabetes, or chronic disorders affect the outcome of surgical interventions.
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The use of alcohol or drugs and smoking are potential risk factors for intraoperative and postoperative orthopedic management.
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Access to advanced technology (augmented reality in orthopedics) enhances orthopedic interventions and treatment outcomes.
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Positive relationships, employment security, and social support systems facilitate the free flow of treatment procedures.
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Societal-level factors include safe accessibility, clean housing facilities, maximum insurance, cultural resources, and mental well-being resources.
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Provider-level factors include effective communication between orthopedic surgeons, healthcare providers, and patients.
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Communities living in complex geographical areas experience a need for transportation, limited access to healthcare systems, and negligible informational networks.
How to Overcome Health Disparities in Orthopedics?
Health disparities are evident in diverse orthopedic treatment modalities. Various health organizations and clinical, regulatory committees strategically plan and implement certain protocols to overcome these differences.
Some of the recent measures include -
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Global orthopedic organizations (the American Academy of Orthopaedic Surgeons) have started initiative programs (calls to arms) to respond immediately to health disparities in orthopedic management.
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Action plans are established to eliminate disparities in care for musculoskeletal disorders by increasing networking facilities.
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Communication lines and telemedicine platforms are authorized to enhance patient-provider communication, thereby effectively reducing health disparity.
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Worldwide, orthopedic communities are acknowledging the disparities in treatment modalities and taking initiatives to reduce them. They also work to enhance the diversification of orthopedic care providers, which would eventually result in better therapeutic outcomes.
Conclusion
Health disparities are major setbacks in orthopedic management and healthcare systems. Various social, economic, and environmental determinants contribute to such disparities. Identifying and eliminating their causes has been a prime concern of the orthopedic fraternity in recent years. Increased diversity and skill development among healthcare providers would improve maximum access and equal utilization of superior orthopedic care.
