Disparities in Outpatient Care following Upper Extremity Nerve Injury: Associations with Disadvantaged Neighborhoods
Andrew L O'Brien, MD, MPH1, James S Lin, MD2, Ryan Schmucker, MD1 and Amy M Moore, MD3, 1The Ohio State University Medical Center, Columbus, OH, 2The Ohio State University, Columbus, OH, 3Division of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
Introduction
Peripheral nerve injuries of the upper extremity can have devastating effects, and many patients face numerous barriers to high-quality care following such injuries. The Area Deprivation Index (ADI) is a measure of neighborhood disadvantage that includes domains such as income, education, employment, and housing quality. In this study, we use the ADI to shed light on the associations of these important social determinants of health (SDOH) on appropriate outpatient care following nerve injury.
Materials and Methods
Retrospective chart review identified patients who presented to the emergency department with upper extremity nerve injuries at single institution from 2016-2021. Data on demographics and injury characteristics were collected. Home addresses were used to assign a state-level ADI score from 1-10, with scores of >7 representing “high-deprivation” neighborhoods, and scores <7 representing “low-deprivation” neighborhoods. Primary outcomes included being lost-to-follow-up (LTFU), and attendance of first outpatient follow-up.
Results
Ninety patients with nerve injuries were identified. Seventy-six patients (84%) presented with distal injuries (elbow and distal), while more proximal injuries (above the elbow) were less common (n=16), only 10 of which were brachial plexus injuries. The most common payer-type was Medicaid (n=36, 40%), followed by privately-insured patients (n=21, 23%). Of those patients for whom an ADI score was available (n=72), 26 (36%) were from an area of high-deprivation.
Seventy-three patients (81.1%) attended their first follow-up; however, more than half (n=51, 56.7%) were eventually LTFU. A greater proportion of patients with proximal injuries were LTFU compared to distal injuries (0.88 vs 0.5, p=0.006). In a univariate analysis, Medicaid patients had 3.5 greater odds of being LTFU, compared to privately-insured patients (p=0.031). When considering the ADI, there was no difference between high- and low-deprivation patients at first follow-up; however, 80.8% (n=21) patients those patients from a high-deprivation neighborhood were eventually LFTU, compared to 39.1% of patients from lower-deprivation areas (p<0.001). There were no statistical differences in LTFU with respect to ). In a multivariate model, those from high-deprivation neighborhoods had 5 times the odds of being LTFU (p=0.012) than those low-deprivation neighborhoods when controlling for payer-type and level of injury.
Conclusion
SDOH have a considerable impact on patients’ ability to adhere to appropriate follow-up following nerve injury. Residence in an area of disadvantage is associated with increasing odds of being LTFU. This study supports that neighborhood-level data represents an important avenue for future research and intervention for nerve injury patients and their outcomes.
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