Social determinants of health disparities are associated with lower total shoulder arthroplasty utilization and increased medical complications: A propensity-matched analysis.

Abstract

Background Total shoulder arthroplasty (TSA) is an effective treatment for glenohumeral osteoarthritis (GHOA), with utilization increasing over time. While prior studies have examined racial and ethnic disparities, the impact of broader social determinants of health (SDOH) on TSA utilization and outcomes remains unclear. Methods The TriNetX database was used to identify patients with GHOA and stratify them by SDOH disparities. Patients were matched 1:1 using propensity scores. The primary outcome was TSA utilization within 5 years. Secondary outcomes included 90-day and 1-year postoperative complications. Bonferroni correction was applied. Results After matching, 84,767 patients were included per utilization cohort. TSA utilization was higher in patients without SDOH disparities (5.78% vs. 3.14%, p < 0.001). The complications cohorts included 2071 patients each. The SDOH cohort had higher rates of emergency department visits and cardiac events at 90 days and 1 year (p < 0.001). At 1 year, acute kidney injury, urinary tract infection, pneumonia (p < 0.001), and pulmonary embolism (p = 0.002) were also higher. Mechanical complications were higher at 1 year on unadjusted analysis only. Revision, periprosthetic joint infection, and fracture rates were similar. Conclusions SDOH disparities are associated with lower TSA utilization and increased postoperative medical complications, suggesting disparities in access to care and healthcare utilization rather than surgical durability. Level of evidence Level III.