Socioeconomic differences in the utilization of diagnostic imaging and non-pharmaceutical conservative therapies for spinal diseases.
Back pain
Healthcare disparities
Routine healthcare data
Spinal diseases
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
02 Oct 2023
02 Oct 2023
Historique:
received:
01
02
2023
accepted:
23
09
2023
medline:
4
10
2023
pubmed:
3
10
2023
entrez:
2
10
2023
Statut:
epublish
Résumé
A different utilization of health care services due to socioeconomic status on the same health plan contradicts the principle of equal treatment. We investigated the presence and magnitude of socioeconomic differences in utilization of diagnostic imaging and non-pharmaceutical conservative therapies for patients with spinal diseases. The cohort study based on routine healthcare data from Germany with 11.7 million patient-years between 2012 and 2016 for patients with physician-confirmed spinal diseases (ICD-10: M40-M54), occupation and age 20 to 64 years. A Poisson model estimated the effects of the socioeconomic status (school education, professional education and occupational position) for the risk ratio of receiving diagnostic imaging (radiography, computed tomography, magnetic resonance imaging) and non-pharmaceutical conservative therapies (physical therapy including exercise therapy, manual therapy and massage, spinal manipulative therapy, acupuncture). Patients received diagnostic imaging in 26%, physical therapy in 32%, spinal manipulative therapy in 25%, and acupuncture in 4% of all patient-years. Similar to previous survey-based studies higher rates of utilization were associated with higher socioeconomic status. These differences were most pronounced for manual therapy, exercise therapy, and magnetic resonance imaging. The observed differences in health care utilization were highly related to socioeconomic status. Socioeconomic differences were higher for more expensive health services. Further research is necessary to identify barriers to equitable access to health services and to take appropriate action to decrease existing social disparities.
Sections du résumé
BACKGROUND
BACKGROUND
A different utilization of health care services due to socioeconomic status on the same health plan contradicts the principle of equal treatment. We investigated the presence and magnitude of socioeconomic differences in utilization of diagnostic imaging and non-pharmaceutical conservative therapies for patients with spinal diseases.
METHODS
METHODS
The cohort study based on routine healthcare data from Germany with 11.7 million patient-years between 2012 and 2016 for patients with physician-confirmed spinal diseases (ICD-10: M40-M54), occupation and age 20 to 64 years. A Poisson model estimated the effects of the socioeconomic status (school education, professional education and occupational position) for the risk ratio of receiving diagnostic imaging (radiography, computed tomography, magnetic resonance imaging) and non-pharmaceutical conservative therapies (physical therapy including exercise therapy, manual therapy and massage, spinal manipulative therapy, acupuncture).
RESULTS
RESULTS
Patients received diagnostic imaging in 26%, physical therapy in 32%, spinal manipulative therapy in 25%, and acupuncture in 4% of all patient-years. Similar to previous survey-based studies higher rates of utilization were associated with higher socioeconomic status. These differences were most pronounced for manual therapy, exercise therapy, and magnetic resonance imaging.
CONCLUSIONS
CONCLUSIONS
The observed differences in health care utilization were highly related to socioeconomic status. Socioeconomic differences were higher for more expensive health services. Further research is necessary to identify barriers to equitable access to health services and to take appropriate action to decrease existing social disparities.
Identifiants
pubmed: 37784063
doi: 10.1186/s12891-023-06909-6
pii: 10.1186/s12891-023-06909-6
pmc: PMC10544477
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
774Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Eur J Public Health. 2017 Feb 1;27(suppl_1):55-62
pubmed: 28355646
Phys Ther. 2011 Apr;91(4):484-95
pubmed: 21330449
Healthc Policy. 2009 Aug;5(1):87-101
pubmed: 20676253
Eur J Public Health. 2017 Feb 1;27(suppl_1):73-81
pubmed: 28355650
Arthritis Care Res (Hoboken). 2016 Nov;68(11):1688-1694
pubmed: 26991822
BMJ Open. 2019 Oct 7;9(10):e028001
pubmed: 31594869
J Health Soc Behav. 2010;51 Suppl:S28-40
pubmed: 20943581
CMAJ. 2005 Nov 8;173(10):1173-7
pubmed: 16275968
Cien Saude Colet. 2019 Oct 28;24(11):4211-4226
pubmed: 31664394
Neurosurgery. 2015 Nov;77(5):746-53; discussion 753-4
pubmed: 26214318
Spine J. 2022 May;22(5):793-809
pubmed: 34848343
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012 Feb;55(2):238-44
pubmed: 22290168
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
Health Serv Res. 2014 Jun;49(3):950-70
pubmed: 24949515
Z Gastroenterol. 2021 Jul;59(7):644-656
pubmed: 34171930
Spine (Phila Pa 1976). 2012 Sep 1;37(19):1708-18
pubmed: 22020590
Phys Ther. 1997 Oct;77(10):1040-51
pubmed: 9327819
Spine (Phila Pa 1976). 2006 Jan 15;31(2):212-8
pubmed: 16418643
BMC Health Serv Res. 2018 Dec 17;18(1):970
pubmed: 30558605
J Health Soc Behav. 1995;Spec No:80-94
pubmed: 7560851
J Epidemiol Community Health. 2000 Apr;54(4):299-305
pubmed: 10827913
Eur J Public Health. 2017 Feb 1;27(suppl_1):82-89
pubmed: 28355635
Br J Pain. 2022 Feb;16(1):109-118
pubmed: 35111319
Neurosurgery. 2015 Oct;77 Suppl 4:S46-50
pubmed: 26378357
Eur J Pain. 2019 Sep;23(8):1425-1436
pubmed: 31038816