Low socioeconomic status worsens access to care and outcomes for rotator cuff repair: a scoping review

Background Poor socioeconomic (SES) status is consistently associated with poor quality of healthcare, particularly in the field of orthopedics. Expanding insurance coverage has created a larger patient population by specifically making healthcare more accessible, translating to greater demand for care in the low SES population. The purpose of this article is to provide a scoping review of literature observing access and outcomes of rotator cuff repair surgery among low SES populations. Methods We performed a systematic review of articles using PubMed, Embase, and EBSCO (May 2021) from 2010 onward. Peer-reviewed articles that recorded at least one SES measure specific to rotator cuff repair patients from the United States were included. SES measures were methodically defined as income, occupation, employment, education, and race. All data that aligned with these SES measures were extracted. Results Of the 1009 titles reviewed, 109 studies were screened by abstract, 23 were reviewed in full, and 7 studies met criteria for inclusion. Of the 5 studies investigating access, all 5 found disparities amongst postoperative physical therapy, orthopedic consult, and surgery, using Medicaid status as a proxy for income in addition to other income measures. Of the 3 studies analyzing outcomes, 2 found that low SES patients had worse pain and function, again based on Medicaid status and other income measures. Education did not have a significant impact on outcomes, according to the 1 study that included it. No studies included measures of occupation or employment. Conclusion Patients of low SES face reduced access to cuff repair care and worse associated outcomes, despite federal and state government efforts to reduce healthcare disparity through healthcare reform. The small nature of this review reflects how measures of SES are often not examined in rotator cuff repair studies.