The Effect of Race and Social Vulnerability on the Management of Thumb Carpometacarpal Osteoarthritis

TL;DR

This study shows that race and social vulnerability influence treatment decisions for thumb osteoarthritis, with non-White patients less likely to receive certain treatments.

Contribution

The study reveals racial and social disparities in the management of thumb osteoarthritis treatment decisions.

Findings

Non-White patients were less likely to receive splinting and CMC arthroplasty compared to White patients.

Non-White patients had higher rates of steroid injections and greater social vulnerability.

White race was associated with increased odds of undergoing CMC arthroplasty.

Abstract

Introduction

Thumb carpometacarpal (CMC) osteoarthritis is one of the most common hand arthropathies. There is significant variability in treatment, and understanding how race and social vulnerability impact treatment decisions is essential for equitable care. The purpose of this study is to examine the effect of race and social vulnerability on the management of patients with thumb CMC osteoarthritis.

Methods

A retrospective review of 270 patients presenting to one community-based health system for CMC osteoarthritis from December 2014 to February 2023 was performed. Patient demographics, comorbidities, patient-reported outcomes, social vulnerability index (SVI), and Eaton-Littler classification were collected. Patients were classified by race and SVI. The primary outcome of interest was CMC arthroplasty. Secondary outcomes included non-operative treatment and time to surgery.

Results

On average, non-White patients were younger (p=0.033), had increased BMI (p=0.001), and were more likely females (p=0.002). Additionally, non-White patients were more socially vulnerable overall than White patients (p<0.001). Non-White patients had a higher rate of steroid injection (p=0.018), a lower rate of splinting (p<0.001), and a lower rate of CMC arthroplasty (21.5% vs. 35.6%; p=0.038). On multivariate analysis, non-White patients were 2.17 (p=0.035) times less likely to have CMC arthroplasty than White patients.

Conclusions

Non-White and higher social vulnerability patients are less likely to receive a splint and proceed to CMC arthroplasty. On multivariate analysis, the White race patients were predictive of CMC arthroplasty. On multivariate analysis, White race patients were associated with increased odds of CMC arthroplasty. These findings highlight the association between socioeconomic and racial factors and treatment decisions, suggesting a need for targeted strategies to ensure equitable care.