The impact of socioeconomic status on the management of rotator cuff tears in a publicly funded health care system

Background: Timely access to care after rotator cuff tear is an important factor in treatment success. We sought to determine the relationship between socioeconomic status (SES) and time to treatment among patients who underwent rotator cuff repair (RCR) in a publicly funded health care system, including time from general practitioner diagnosis to orthopedic consultation (T1) and time from orthopedic consultation to surgery (T2). Methods: We conducted a retrospective, population-based cohort study using data from the Manitoba Population Research Data Repository. We calculated T1 and T2 for all patients who underwent RCR between 1990 and 2020. We compared times between SES levels as defined using the Socioeconomic Factor Index–2 (SEFI-2). We compared SES level between surgical and nonsurgical patients with rotator cuff injuries between 2015 and 2020. Results: There were no significant differences in T1 and T2 by SES level (p = 0.4 and p = 0.2, respectively). The odds ratio of having surgery within 1 year after consultation for patients in the lowest SES category was 0.70 (95% confidence interval 0.52 to 0.94) compared with patients in other SES categories. The mean SEFI-2 was −0.21 for surgical patients and −0.03 for nonsurgical patients (p < 0.001). Conclusion: In a publicly funded health care system, patients with lower SES were less likely to undergo RCR than those with higher SES. The odds of waiting longer than 1 year for surgery from the time of orthopedic consultation were greatest among patients with the lowest SES.