Primary Total Knee and Total Hip Arthroplasty in the Rural Patient.

Rural patients have poorer health indicators, including higher risk of developing osteoarthritis. The objective of this study is to compare rural patients undergoing primary total joint arthroplasty (TJA) at rural hospitals with those undergoing primary TJA at urban hospitals with regards to demographics, comorbidities, and complications and to determine the preferred location of care for rural patients. Data from the Healthcare Cost and Utilization Project National Inpatient Sample between 2016 and 2018 were analyzed. Demographics, comorbidities, inpatient complications, hospital length of stay, inpatient mortality, and discharge disposition were compared between rural patients who underwent TJA at rural hospitals and urban hospitals. Rural patients undergoing primary TJA in rural hospitals were more likely to be women, to be treated in the South, to have Medicaid payer status, to have dementia, diabetes mellitus, lung disease, and postoperative pulmonary complications, and to have a longer hospital length of stay. Those patients were also less likely to have baseline obesity, heart disease, kidney disease, liver disease, cancer, postoperative infection, and cardiovascular complications, and were less likely to be discharged home. Rural patients undergoing primary TJA tend to pursue surgery in their rural hospital when their comorbidity profile is manageable. These patients get their surgery performed in an urban setting when they have the means for travel and cost, and when their comorbidity profile is more complicated, requiring more specialized care, Rural patients are choosing to undergo their primary TJA in urban hospitals as opposed to their local rural hospitals. (Journal of Surgical Orthopaedic Advances 33(2):061-067, 2024).

Decreased patient comorbidities and post-operative complications in technology-assisted compared to conventional total knee arthroplasty.

PURPOSE: The use of computer-assisted and robotic surgery was developed to improve component position and outcomes of total knee arthroplasty (TKA). The goal of this study is to identify differences in patient demographics, comorbidities, and complications between technology-assisted and conventional TKA. METHODS: A Nationwide Inpatient Sample database was used to identify patients who underwent technology-assisted and conventional TKA from 2016 to 2018. Analysed variables include demographics, length of stay (LOS), payer-status, geographic region, comorbidities, complications, and mortality. Univariate and multivariate analyses were performed to identify differences between both groups. RESULTS: The analysis includes 2,208,434 TKA patients, of which 2,054,879 (93.05%) were conventional and 153,555 (6.95%) were technology assisted. Patients undergoing technology-assisted TKA were more likely to be older than 65 years, had higher median income quartile, and had surgery in urban teaching hospitals. Patients were less likely to undergo technology-assisted TKA if they were female gender, had Medicare payer status, were black race, were obese, were living in rural location, or had higher Charlson comorbidity score and baseline comorbidities. Technology-assisted TKA patients had shorter LOS, and fewer pulmonary and infection complications. CONCLUSION: Patients undergoing technology-assisted TKA are being carefully selected with less baseline comorbidities, improved health, and living in urban areas. Subsequently, those carefully selected patients are discharged home, have a shorted hospital LOS, and have fewer complications compared to conventional TKA. Rural patients, black race and female gender are less likely to undergo technology-assisted TKA, further emphasizing the healthcare disparity for that segment of the population. LEVEL OF EVIDENCE: Therapeutic level III.

The effect of autoimmune skin disorders on post-operative outcomes following arthroplasty.

INTRODUCTION: The impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. METHODS: Data was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. RESULTS: Among 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89-3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076-1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. CONCLUSION: This study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.

Distal Humerus Fractures in Adults: Comorbidity Patterns and Demographic Trends in Treatment.

The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease. Those undergoing surgery are more likely to be obese, under the age of 40 years, female, Medicare recipients with fewer comorbidities, who reside in a rural setting, and who seek care at urban/teaching hospitals within the Southern United States. They are also more likely to have a shorter hospital stay, to be discharged to home, and to have improved survival. (Journal of Surgical Orthopaedic Advances 32(1):017-022, 2023).

Differences in hospital length of stay and total hospital charge by income level in patients hospitalized for hip fractures.

This study examines the difference in length of stay and total hospital charge by income quartile in hip fracture patients. The length of stay increased in lower income groups, while total charge demonstrated a U-shaped relationship, with the highest charges in the highest and lowest income quartiles. INTRODUCTION: Socioeconomic factors have an impact on outcomes in hip fracture patients. This study aims to determine if there is a difference in hospital length of stay (LOS) and total hospital charge between income quartiles in hospitalized hip fracture patients. METHODS: National Inpatient Sample (NIS) data from 2016 to 2018 was used to determine differences in LOS, total charge, and other demographic/clinical outcomes by income quartile in patients hospitalized for hip fracture. Multivariate regressions were performed for both LOS and total hospital charge to determine variable impact and significance. RESULTS: There were 860,045 hip fracture patients were included this study. With 222,625 in the lowest income quartile, 234,215 in the second, 215,270 in the third, and 190,395 in the highest income quartile. LOS decreased with increase in income quartile. Total charge was highest in the highest quartile, while it was lowest in the middle two-quartiles. Comorbidities with the largest magnitude of effect on both LOS and total charge were lung disease, kidney disease, and heart disease. Time to surgery post-admission also had a large effect on both outcomes of interest. CONCLUSION: The results demonstrate that income quartile has an effect on both hospital LOS and total charge. This may be the result of differences in demographics and other clinical variables between quartiles and increased comorbidities in lower income levels. The overall summation of these socioeconomic, demographic, and medical factors affecting patients in lower income levels may result in worse outcomes following hip fracture.

Anxiety and depression in stroke: An evaluation of these psychopathologies on outcomes of stroke type using the National Inpatient Sample.

BACKGROUND: Anxiety and depression have been reported to complicate the course of stroke. This study evaluated the association of anxiety and depression independently on ischemic vs non-ischemic stroke. METHODS: A cross-sectional survey of 4,983,807 admissions for acute stroke from 1994 to 2013 in the National Inpatient Sample compared stroke patients with depression and anxiety to stroke patients with no psychiatric comorbidities. The database was operationalized based on the inclusion/exclusion criteria approved by the Southern Illinois University School of Medicine Institutional Review Board. RESULTS: Patients with anxiety and depression were more likely to have an ischemic stroke (OR 1.64; 95% CI, 1.61 to 1.68) vs a non-ischemic stroke (OR 1.25; 95% CI, 1.23 to 1.27). Inpatient mortality was significantly less in both the depression and anxiety groups compared to the control group. CONCLUSIONS: Psychiatric disorders (anxiety and depression) may increase the risk of ischemic stroke; however, depressed and anxiety patients with ischemic stroke were less likely to die from stroke. Further well-designed studies are necessary to explore these findings.

Determinants of 90-day readmission following ventral hernia repair with and without myocutaneous flap reconstruction: a National Readmissions Database analysis.

BACKGROUND: Readmission status is an important clinical component of healthcare outcomes. 90-day readmission following complex open ventral hernia repair has not been well studied with national level data. This study aims to compare readmission rates for patients undergoing standard vs. complex (myocutaneous flap-based) ventral hernia repair. We hypothesize that complexity of reconstruction will be an independent predictor of readmission after ventral hernia repair. METHODS: A retrospective cohort study was performed with 1:1 matching of hernia repair type using the National Readmissions Database. Patients were selected using ICD-9 codes corresponding to ventral hernia repair with or without myocutaneous flap. 90-day readmissions were determined on patients within the first through third quarters of each year. After matching, a multivariable logistic regression analysis was performed using confounding variables including hospital setting, comorbidities, type of repair, urgency of repair, sociodemographic status, and payer. Likelihood of 90-day readmission was calculated from odds ratios. RESULTS: Readmission rates were 19.1% (38,313 out of 200,266) and 22.5% (692 out of 3075) at 90-day for standard ventral hernia repair and complex ventral hernia repair, respectively. 3116 standard ventral hernia repair patients were matched with 3074 complex ventral hernia repair patients. After matching there was a significantly increased readmission rate for repairs involving myocutaneous flaps, with odds ratio (OR) 1.30 (95% CI 1.22-1.60). Payer status (OR 1.82; 95% CI 1.21-2.74), teaching hospital status (OR 1.42; 95% CI 1.23-1.64) and income quartile (OR 1.35; CI 1.10-1.65) were independent predictors of readmission. CONCLUSIONS: Patients undergoing myocutaneous flap-based reconstruction have higher readmission rates than those undergoing less complex ventral hernia repair. Socioeconomic disparity as reflected in payer status is a particularly strong predictor of readmission. The data support the concept that focused efforts are needed to optimize patient outcomes for patients requiring more complex repair, including socioeconomically disadvantaged patient populations.

Using a Comanagement Model to Develop a Hip Fracture Integrated Care Pathway.

EXECUTIVE SUMMARY: Hip fracture care represents a service line that profoundly affects patients' quality of life. As hospitals and physicians are motivated to improve quality, reduce costs, and maximize efficiency of care, several alignment models have been proposed under new healthcare legislation. Evaluation of such models as they pertain to hip fracture care warrants further investigation. In this article, we identify the current model of operations present in large healthcare organizations, examine the reasoning behind hospital-physician alignment, and describe specific comanagement principles that are common in healthcare settings. Furthermore, the effects of a comanagement model on a hip fracture integrated care pathway will be demonstrated through a case study. A comanagement team was formed at a Level I academic trauma center to create an integrated care pathway for the hip fracture service line. An internal data review of hip fracture cases before and after implementation of the pathway was undertaken to assess the impact of this model in terms of postoperative outcomes and resource utilization. The postimplementation group displayed more observant care while consuming fewer resources. Thus, the comanagement model described in this article serves as a powerful tool, allowing hospitals and physicians to improve the quality of care. This study provides recommendations based on our success in the hip fracture setting that may be extrapolated to improve service lines and healthcare efficiency nationally.

Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients.

BACKGROUND: As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)). METHODS: Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05. RESULTS: Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts. CONCLUSION: Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.

Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients.

BACKGROUND: Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists. METHODS: Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05. RESULTS: Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities. CONCLUSION: Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.

Impact of diabetes on early postoperative outcomes after total elbow arthroplasty.

BACKGROUND: Diabetes is known to be associated with poorer perioperative outcomes after hip, knee, and shoulder arthroplasty. This study is the first, to our knowledge, to examine the association between diabetes and in-hospital complications, length of stay, non-homebound discharge, transfusion risk, and total charges after total elbow arthroplasty (TEA). METHODS: By use of International Classification of Diseases, Ninth Revision codes, epidemiologic as well as patient and hospital demographic data for all patients undergoing TEA were extracted from the Nationwide Inpatient Sample from 2007 through 2011. We found 13,698 patients who underwent TEA and subsequently separated them into 2 cohorts, those patients with (16.5%) and without (83.5%) diabetes. Specific outcome measures between the diabetic and nondiabetic cohorts were compared through bivariate and multivariate analyses. RESULTS: Diabetic patients had significantly longer lengths of stay, increased rates of needing a transfusion perioperatively, and higher rates of a number of complications after TEA compared with the nondiabetic group. Significant differences in demographic factors in diabetic patients compared with nondiabetic patients included age, gender, insurance type, and geography. Diabetes was an independent predictor of both prolonged hospital stay and non-homebound discharge after TEA. DISCUSSION: Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay, as well as increased risk of non-homebound discharge. Future studies need to further investigate this relationship between diabetes and poorer TEA outcomes.

Inpatient mortality after primary total hip arthroplasty: analysis from the National Inpatient Sample database.

Although inpatient mortality rates following total hip arthroplasty are low, understanding factors that influence inpatient mortality rates is important. Discharge data from the 2007-2008 HCUP Nationwide Inpatient Sample database were used in this study. Patients were identified based on whether they were admitted for a primary total hip arthroplasty and grouped based on their mortality status. All hip and acetabular fracture patients were excluded. Discharge data revealed 508,150 primary total hip arthroplasties with an inpatient mortality rate of 0.13%. The most significant pre-operative predictors of inpatient mortality were increasing age, weekend admission, increased Charlson co-mobidity score, Medicare payer status, race and a Southern hospital region. The two most significant complications post-operatively leading to increased mortality were pulmonary and cardiovascular complications.

Hospital Length of Stay following Primary Total Knee Arthroplasty: Data from the Nationwide Inpatient Sample Database.

Demand and cost of total knee arthroplasty (TKA) has increased significantly over the past decade resulting in decreased hospital length of stay (LOS) to counterbalance increasing cost of health care. The purpose of this study was to determine the factors that influence LOS following primary TKA. Discharge data from the 2009-2011 Nationwide Inpatient Sample were used. Patients included underwent primary TKA and were grouped based on LOS; 3 days or less, and 4 days or more. Majority of patients had a hospital LOS of 3 or less (74.8%). The most significant predictors of increased hospital LOS (≥ 4 days) were age ≥ 80 years, Hispanic race, Medicaid payer status, lower median household income, weekend admission, rural non-teaching hospital, discharge to another facility and any complication.

Long-term survival of patients undergoing mitral valve repair and replacement: a longitudinal analysis of Medicare fee-for-service beneficiaries.

BACKGROUND: Despite the established superiority of mitral repair over replacement, its adoption in the treatment of elderly patients has not been uniform, partly because of a lack of robust long-term survival data. We present the long-term survival of Medicare fee-for-service beneficiaries undergoing mitral valve repair and replacement over a 10-year period. METHODS AND RESULTS: We used the Medicare database to identify 47 279 fee-for-service beneficiaries ≥65 years of age undergoing primary isolated mitral valve repair or replacement from 2000 to 2009. Operative mortality and long-term survival are presented for repair and replacement. Operative mortality was 3.9% for patients undergoing repair and 8.9% for patients undergoing replacement. The 1-, 5-, and 10-year Kaplan-Meier survival estimates for patients undergoing repair were 90.9%, 77.1%, and 53.6%. The 1-, 5-, and 10-year Kaplan-Meier survival estimates for patients undergoing replacement were 82.6%, 64.7%, and 37.2%. Important predictors of mitral repair included younger age (odds ratio, 1.10; 95% confidence interval, 1.05-1.14), elective admission status (odds ratio, 1.34; 95% confidence interval, 1.27-1.41), and annual mitral procedure volume >40 cases per year (odds ratio, 1.57; 95% confidence interval, 1.36-1.81). Female sex and the presence of comorbidities were associated with a lower likelihood of repair. CONCLUSIONS: Mitral valve surgery in the Medicare population carries less risk than previously reported. Given the favorable outcomes of elderly patients undergoing mitral valve surgery, especially mitral valve repair, an approach of earlier identification and surgical referral appears justified regardless of age.

Correlation of WOMAC and KOOS scores to tibiofemoral cartilage loss on plain radiography and 3 Tesla MRI: data from the osteoarthritis initiative.

PURPOSE: The purpose of this study was to determine the correlation between the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Knee Injury Osteoarthritis Outcomes scores (KOOS) and the degree of tibiofemoral cartilage loss on plain radiography and 3T magnetic resonance imaging (MRI). We hypothesize that these subjective outcome scores will have a significant correlation to quantitative joint space loss. METHODS: Data used in the preparation of this article were obtained from the osteoarthritis initiative (OAI) database (OAI public use data sets kMRI_QCart_Eckstein18 and kXR_QJSW_Duryea16). Four hundred and forty-five patients had WOMAC/KOOS scores, quantitative tibiofemoral joints space width on plain radiographs and quantitative tibiofemoral cartilage thickness and per cent full thickness cartilage loss on 3T MRI. Joint space width on plain radiographs was correlated to cartilage thickness on MRI, and WOMAC/KOOS scores were correlated to the degree of cartilage loss using Pearson correlation coefficients. RESULTS: There was a statistically significant correlation between medial and lateral compartment cartilage thickness on MRI and medial and lateral joint space width on plain radiography (r = 0.86, r = 0.80) (p < 0.001). KOOS knee pain score was significantly correlated to increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.34) (p < 0.001). KOOS symptom score was significantly correlated to decreasing joint space width in the medial (r = 0.16) and lateral (r = 0.15) compartment and increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.36) (p < 0.001). No WOMAC score was correlated to degree of joint space width, cartilage thickness or per cent full thickness cartilage loss (n.s). CONCLUSION: The WOMAC and KOOS scores are poor indicators of tibiofemoral cartilage loss, with only the KOOS symptom and knee pain score being weakly correlated. Osteoarthritis is a multifactorial process and the need to treat patients based off their symptoms and rely on radiographs as confirmatory modalities, and not diagnostic modalities, when talking about OA and medical intervention.

Rural vs. urban utilization of total joint arthroplasty.

The purpose of this study was to analyze the association between patient demographics and hospital demographics on utilization of total joint arthroplasty in rural and urban populations from the National Inpatient Sample database. Any patient that was discharged after a primary total hip or primary total knee arthroplasty was included in this study. Results showed that rural patients living in a Northeastern hospital region compared to West, less than 65 years of age, females, Blacks and Hispanics were less likely to undergo total joint arthroplasty compared to their urban counterparts. Rural patient were more likely to undergo total joint arthroplasty compared to their urban counterparts if they were in the Midwest and had Medicare as their primary payer provider.

WITHDRAWN: Inpatient Mortality After Primary Total Hip Arthroplasty: Analysis From The National Inpatient Sample Database.

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Autologous Breast Reconstruction is Associated with Lower 90-day Readmission Rates.

BACKGROUND: Breast reconstruction is associated with improved quality of life after mastectomy. Options for breast reconstruction include autologous and implant-based methods. Although autologous reconstruction is more technically challenging and requires longer operative time, it is thought of as the gold standard. Our study examined differences in 90-day readmission rates between implant-based and autologous breast reconstruction using discharge data from the National Readmission Database, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. METHODS: The National Readmission Database was used to identify patients undergoing postmastectomy breast reconstruction. Patients were selected using ICD-10 PCS codes linked to autologous and implant-based reconstruction. Ninety-day readmission rates were determined. After matching the two groups on a 1:1 basis for baseline comorbidities and demographics, a multivariable logistic regression analysis was performed to variables associated with higher readmission rates. RESULTS: The leading diagnoses associated with readmissions were infectious and pulmonary. After one to one matching, autologous breast reconstruction, private insurance versus Medicaid, and income quartile 4 versus 1 were all less likely to be readmitted within 90 days of discharge. Patients with a high Charlson index and those with a longer length of initial hospital stay are significantly more likely to be readmitted within 90 days. CONCLUSIONS: Patients undergoing autologous breast reconstruction were 23% less likely to be readmitted within 90 days from discharge. Fewer comorbidities, shorter length of hospital stay, and higher socioeconomic status are also associated with lower readmission rates following breast reconstruction.

Rural-urban differences in behaviors to prevent skin cancer: an analysis of the Health Information National Trends Survey.

BACKGROUND: There is concern that rural residents may be less likely to engage in behaviors to reduce their risk for skin cancer compared with urban residents. OBJECTIVES: First, we sought to determine whether rural residents are less likely to use sunscreen and engage in other skin cancer preventive measures. Second, we sought to determine whether such actions are sufficiently explained by factors known to affect these behaviors or whether such actions are affected by rurality. METHODS: We analyzed the 2005 Health Information National Trends Survey, a survey of the noninstitutionalized, adult population performed by the National Cancer Institute. We used logistic regression analysis to adjust for confounding by age, race, income, education, health insurance, smoking, sex, marital status, and region. RESULTS: Compared with urban residents, rural residents were 33% less likely (odds ratio = 0.67; 95% confidence interval, 0.57-0.80) to wear sunscreen when exposed to the sun for more than 1 hour. After adjusting for the above confounding variables, however, rural individuals were just as likely as urban individuals to use sunscreen with sun exposure. LIMITATIONS: Inability to adjust for unmeasured confounding variables, such as occupational sun exposure, is a limitation. CONCLUSION: Rural residents were less likely to use sunscreen. This decreased use of sunscreen, however, was explained by differences in age, race, income, education, and other confounding factors that negatively influence the use of sunscreen.

Uveitis and health disparities: results from the National Inpatient Sample.

PURPOSE: Health disparities exist when the prevalence or outcome of the disease are influenced by age, race, sex or income. Health disparities are prevalent in autoimmune diseases. However, there is a lack of national US data regarding health disparities in uveitis. The primary aim of our study is to evaluate health disparities for uveitis in the USA. METHODS: We performed a retrospective, observational, cross-sectional study to ascertain health disparities for uveitis and its complications in the USA using the National Inpatient Sample (NIS) for the years 2002-2013. We used the International Classification of Disease, ninth revision, codes to identify uveitis cases and ocular complications. Uveitis was divided into total, infectious and non-infectious uveitis. We collected information on age, sex, race, income quartile and ocular complications. We preformed statistical analysis using SAS V.9.4. A logistic regression model was used to predict the odds of developing uveitis and its complications. RESULTS: There were a total of 94 143 978 discharges including 15 296 total uveitis, 4538 infectious and 10 758 non-infectious uveitis patients. Compared with the total NIS population, patients with uveitis were younger (mean age 45±18 vs 48±28 years, p value ≤0.0001, African-Americans (23% vs 10%, p value ≤0.0001), in the lowest income quartile (<$38 999; 29% vs 26%, p value ≤0.0001) and were insured by Medicaid (25% vs 20%, p value ≤0.0001). CONCLUSION: African-American patients have a higher prevalence of uveitis. Patients insured by Medicare and Medicaid have more frequent ocular complications. This knowledge may guide future research on disparity and shape healthcare decision making.