TY - JOUR T1 - Scratching the Surface: Itching for Evidence to Reduce Surgical Health Disparities in Total Shoulder Arthroplasty JF - The Journal of Rheumatology JO - J Rheumatol SP - 490 LP - 492 DO - 10.3899/jrheum.190796 VL - 47 IS - 4 AU - SHAO-HSIEN LIU AU - KATE L. LAPANE Y1 - 2020/04/01 UR - http://www.jrheum.org/content/47/4/490.abstract N2 - Total shoulder arthroplasty (TSA) is an effective procedure to improve symptoms, function, and quality of life for patients with different clinical conditions that affect the shoulder1,2. TSA use has been increasing in the United States3,4, but whether the short-term and longterm beneficial effects extend to all recipients is less clear. In this issue of The Journal, research by Singh and Cleveland5 adds to the growing body of literature evaluating the link between socioeconomic status (including insurance and income status) and postsurgical outcomes in patients with TSA. In this study, the authors conclude that public insurance, such as Medicaid and Medicare, were independently associated with more healthcare use (e.g., length of hospitalization and discharge to rehabilitation facilities) and suboptimal clinical outcomes, whereas lower income status was associated with less healthcare use and fewer postsurgical complications after TSA. The findings run counter to their hypothesis.The study offers clear advantages relative to previous research. First, the authors used the National Inpatient Sample (NIS), a nationally representative sample generalizable to all shoulder arthroplasties performed in the United States. This publicly available database with all-payer inpatient care data reduces the likelihood of selection bias that may occur in a single or multisite retrospective design6. The authors combined more than 15 years … Address correspondence to S.H. Liu, Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St., Worcester, Massachusetts 01605, USA. E-mail: shaohsien.liu{at}umassmed.edu ER -