Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus

Table 4 Medicare proximal humerus fracture patient characteristics by local area HRR surgical management quintiles

	Quintiles of surgical management area treatment ratios						p
	Total population	1	2	3	4	5	p
N	77,053	15,675	15,648	15,125	15,831	14,774
Surgical management average area treatment ratio	1	0.65	0.88	0.98	1.13	1.36
Average surgery rate, %	15.4	9.9	13.7	15.1	17.2	21.1
Patient demographics
Male, %	19.9	20.3	19.8	19.8	19.7	19.8	0.27
Mean age	80.3	80.6	80.2	80.1	80.3	80.0	< 0.001
Age group, %
66–69	13.0	12.1	13.6	13.0	13.3	13.0
70–75	20.5	19.4	20.4	21.1	20.1	21.7
76–79	14.9	15.0	14.8	15.0	14.6	15.3
80–85	24.8	25.4	24.1	25.1	25.0	24.5
86+	26.7	28.0	27.1	25.7	27.1	25.6
Race, %							0.04
Asian	0.9	0.8	0.8	0.9	1.6	0.4
Black	3.1	2.6	3.3	3.1	3.4	3.3
Hispanic	1.4	1.0	1.1	2.1	1.5	1.0
Other	1.2	1.2	1.3	1.4	1.4	0.8
White	93.4	94.4	93.6	92.4	92.1	94.5
Fully dual eligible¹, %	13.8	15.5	12.5	14.1	15.4	11.1	< 0.001
Charlson Comorbidity Index², %
0	24.4	23.9	25.8	23.6	25.2	23.6	0.42
1	20.2	20.1	20.5	20.1	20.5	19.9	0.62
2	15.5	15.2	15.7	15.9	15.3	15.5	0.92
3	12.4	12.5	12.0	12.5	12.0	12.8	0.58
4+	27.5	28.2	26.0	28.0	26.9	28.2	0.45
Frailty Risk Index (FRI)
0	34.1	33.8	35.2	34.2	34.2	33.2	0.09
1	25.9	26.2	26.0	25.5	25.5	26.3	0.62
2	15.9	16.1	15.5	15.6	15.8	16.3	0.65
3+	24.1	23.8	23.3	24.7	24.5	24.3	0.04
Shoulder diagnoses in the previous 365 days
Osteoarthritis	25.4	24.3	24.0	26.0	26.0	26.9	< 0.001
Rheumatoid arthritis	8.0	8.4	7.6	8.4	7.6	7.9	0.12
Rotator cuff arthropathy	6.6	6.6	6.3	6.2	6.2	7.5	0.02
Avascular necrosis	0.2	0.2	0.2	0.1	0.2	0.2	0.81
Previous year Medicare spending³	$15,623	$16,279	$14,831	$15,738	$15,581	$15,692	< 0.001

Cochrane-Armitage used to asses trends across ATR quintiles
¹Beneficiary was fully dual-eligible for Medicare and Medicaid during the month of the index fracture
²Charlson Comorbidity Index
³Total Part A and B payments made by Medicare for the beneficiary over the period of 365 days prior to their index fracture date

ISSN: 1749-799X