The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States

The Landmark Series: Surgical Oncology Care in Native Americans-The Indian Health Service

American Indian and Alaska Natives (AI/ANs) are a heterogeneous group of people living throughout the USA with some of the highest cancer incidence and highest cancer-related mortality in the country. This landmark series seeks to highlight cancer care in this population by providing a historical context of the largest healthcare delivery system serving AI/ANs, the Indian Health Service (IHS). We will highlight how the dynamic nature of this population creates unique challenges and the need for dedicated resources to help eliminate cancer care disparities.

Native American Representation and Diversity Initiatives Within Orthopaedic Surgery: An Update and Road Map to Success

Orthopaedic surgery lags behind other specialties in terms of diversity. This lack of representation is especially evident within the Native American population. Native American/Alaskan Natives represent approximately 2.9% of the overall US population but comprise just 0.4% of orthopaedic surgeons within the United States. Currently, no Native American-specific orthopaedic inclusion or recruitment programs exist. There are a multitude of programs that exist to recruit Native American applicants into health care. These include pipeline programs and scholarships from the Indian Health Service (IHS), mentorship programs from a multitude of Native American medical societies, and IHS recruitment programs targeted at Native American preferential hiring. Dozens of grants and national diversification programs that are not specific to Native Americans are also available. Programs such as the AAOS IDEA Grant, Nth Dimensions, and The Perry Initiative have been successful in diversifying the orthopaedic surgery pipeline. This review highlights the paucity of Native American representation within orthopaedics and identifies current programs and resources for Native Americans. This article serves as a guide for Native Americans pursuing a career in orthopaedic surgery, as well as inspiration for future programs directed at increasing Native American representation.

Healthcare segregation in orthopedic surgery: A statewide analysis of American Indian and Alaska Native patients

Significant health disparities have been described for American Indian and Alaska Native (AIAN) patients undergoing various surgical procedures, however, research into healthcare segregation within orthopedic surgery has been limited. In this study, our purpose was to assess if AIAN patients were more likely to be treated by lower-volume surgeons and at lower-volume hospitals. AIAN and White patients who underwent one of four common orthopedic procedures (knee or hip arthroplasty, femur or tibia repair) were identified from a Washington state inpatient database. Demographic, socioeconomic, geographic, and procedure data were surveyed, and volumetric thresholds were established for lower versus higher volume surgeons and hospitals. Adjusted odds ratios were calculated for AIAN patients receiving care from a lower volume surgeon or hospital, including covariates for patient demographics, geographic, and socioeconomic status. AIAN patients were more likely to receive care from a lower-volume surgeon for all procedures except tibial repair. Adjusted odds ratios of 1.53 (95% confidence interval [CI]: 1.22, 1.92) and 1.68 (95% CI: 1.26, 2.21) were found for AIAN patients receiving knee or hip arthroplasty from a lower volume surgeon, respectively. There was no strong evidence of AIAN patients being more likely to receive care at a lower-volume hospital. Finally, AIAN patients having knee arthroplasty at a higher volume hospital were more likely to have their surgery performed by a lower volume surgeon. These data suggest that there may be significant healthcare segregation among AIAN patients across common orthopedic surgical procedures.

Trends in Orthopaedic Surgery Workforce Diversity: Analyzing Changes Over Time

INTRODUCTION

There are many reasons why orthopaedic surgeons move or change careers. We asked the questions: (1) What is the geographic distribution of orthopaedic surgeons with respect to age, sex, and race and ethnicity? (2) How has our workforce changed over time with regard to these factors? (3) Are there any patterns or trends detected regarding policy or regulatory events that coincide with these differences?

METHODS

The American Academy of Orthopaedic Surgeons surveys over 30,000 members, collecting data on demographics, age, race sex, and practice statistics. We calculated geographic distributions and evaluated these differences over time-potential influences from malpractice suits or tort reform were investigated.

RESULTS

Overall surgeon density increased over time. The largest negative changes were noted in District of Columbia, Wyoming, and North Dakota and positive changes in Colorado, South Dakota, and West Virginia. Age across all states increased (mean 1.7 years). Number of female surgeons increased in most states (4.6% to 5.7%). Number of  African Americans increased from 1.6% to 1.8%, Hispanic/LatinX from 1.8% to 2.2%, Asian from 5.5% to 6.7%, and multiracial from 0.8% to 1.2%. No change was noted in the percentage of Native American surgeons.

DISCUSSION

Surgeon density increased from 2012 to 2018; the cause for this change was not evident. Small increases in surgeon population, female surgeons, and in some underrepresented minorities were seen.

What do we know about Indigenous Peoples with low back pain around the world? A topical review

BACKGROUND

Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples.

METHODS

A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted.

RESULTS

LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world.

CONCLUSION

Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.