Fri., 10/17/08 Pelvis/Injury Prevention, Paper #34, 12:30 pm OTA-2008
Ethnic Disparities in Functional and Mental Recovery following Fracture Healing
Michael G. Walsh, PhD (a-New York University Hospital for Joint Diseases);
Roy I. Davidovitch, MD (n); Kenneth A. Egol, MD (a-Smith + Nephew, Stryker, Synthes;
a,b-Biomet; b-Exactech, Inc; d-Johnson & Johnson);
New York University-Hospital for Joint Diseases, New York, New York, USA
Purpose: Physical function following fracture of the distal radius is often diminished over time. Ethnic disparities have long been manifest in chronic disease, such as diabetes and heart disease, but it is less clear whether similar disparate patterns appear with respect to recovery following traumatic fracture of the distal radius.
Methods: We examined 493 individuals (250 whites, 100 blacks, and 143 Latinos) who had sustained a fracture involved the wrist, who were enrolled in our university trauma registry. Assessment of physical function, pain, and mental well-being was conducted at 3, 6, and 12 months following treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to assess physical function, a visual analog scale used to assess pain, and the Short Form-36 used to assess mental well-being. Multiple linear regression was used to model physical function, pain, and well-being, respectively, across ethnicity, while controlling for age, gender, mechanism of injury, level of education, type of fracture, and type of treatment.
Results: 77% of patients had completed minimum 1-year follow-up and form the basis of this report. Blacks experienced poorer physical function than whites, with more than a 10- point DASH differential at each of the 3-, 6-, and 12-month follow-up periods (P <0.001 at 3, 6, and 12 months). Latinos did not experience a difference in physical function compared to whites at any time point. Latinos did, however, report 2 times more pain at each follow-up point compared to blacks and whites (P >0.001 at 3, 6, and 12 months), and subsequently manifested 25% poorer mental well-being at 1 year of follow-up relative to both blacks and whites (P = 0.008).
Conclusion and Significance: These findings suggest that convalescence does not occur equitably across ethnicity following fracture of the distal radius. These ethnic disparities may result from differential access to care following initial fracture treatment and highlight the need for vigilance in the application of follow-up care across diverse populations.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.