Variation in hip fracture treatment: are black and white patients treated equally?

To examine disparity in race for hip fracture treatment, we identified femoral neck fractures and pertrochanteric fractures from a 20% sample of 1999-2003 Medicare part B claims data and stratified patients by treatment: total hip arthroplasty (THA), hemiarthroplasty (HA), open reduction and internal fixation (ORIF), and nonoperative management (NM). Covariables included patient race, age, sex, and Charlson Comorbidity Index score. The geographic variable was the hospital referral region (306 such US regions are defined in The Dartmouth Atlas of Health Care). Logistic regression was performed to evaluate the independent effect of each variable on treatment received. There were 49,755 femoral neck fractures (94% white patients) and 90,440 pertrochanteric fractures (94% white). For femoral neck fractures, no significant differences were found by race (P=.16) in adjusted mean rates for THA (2.73%), HA (77.8%), ORIF (26.9%), or NM (2.95%). For pertrochanteric fractures, no significant differences were found (P=.09) in adjusted mean rates for THA (0.47%), HA (8.24%), ORIF (94.8%), or NM (2.11%). There were no significant disparities by race across hospital referral regions with regard to type of fracture treatment.