title: Racial disparities in total ankle arthroplasty utilization and outcomes.
abstract: BACKGROUND
  The objective of this study was to examine the racial disparities in total ankle arthroplasty (TAA) utilization and outcomes.
  
  
  METHODS
  We used the National Inpatient Sample (NIS) to study the time-trends. Race was categorized as White and Black. Utilization rates were calculated for the U.S. general population per 100,000. Hospital length of stay, discharge disposition and mortality after TAA were assessed. We used the Cochran Armitage trend test to assess time-trends from 1998 to 2011 and chi-square test to compare TAA utilization. We used analysis of variance or chi-squared test to compare the characteristics of Whites and Blacks undergoing TAA and logistic regression to compare mortality, length of stay and discharge to home versus medical facility.
  
  
  RESULTS
  The mean ages for Whites undergoing TAA were 62 years and for Blacks was 52 years. Significant racial disparities were noted in TAA utilization rates (/100,000) in 1998, 0.14 in Whites vs. 0.07 in Blacks (P<0.0001; 2-fold) and in 2011, 1.17 in Whites vs. 0.33 in Blacks (P<0.0001; 4-fold). Racial disparities in TAA utilization increased significantly from 1998 to 2011 (P<0.0001). There was a trend towards statistical significance for the difference in the length of hospital stay in Blacks vs. Whites (52.9% vs. 44.3% with length of hospital stay higher than the median; P=0.08). Differences in the proportion discharged to an inpatient medical facility after TAA, 16.6% Blacks vs. 13.4% Whites, were not significant (P=0.36).
  
  
  CONCLUSIONS
  This study demonstrated significant racial disparities with lower TAA utilization and suboptimal outcomes in Blacks compared to Whites. Further studies are needed to understand the mediators of these disparities and to assess whether these mediators can be targeted to reduce racial disparities in TAA.
authors.affiliation: Medicine Service, Birmingham VA Medical Center, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. jassingh@uab.edu.|Department of Medicine at the School of Medicine and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. jassingh@uab.edu.|Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA. jassingh@uab.edu.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Department of Medicine at the School of Medicine and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. rrekha@uab.edu.
authors.forename: Rekha
authors.initials: R
authors.lastname: Ramachandran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010003:Osteoarthritis / Q000208:ethnology* / Q000601:surgery; D044469:Racial Groups; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology