Disparities in Surgical Intervention and Health-Related Quality of Life Among Racial/Ethnic Groups With Degenerative Lumbar Spondylolisthesis.
Humans
Spondylolisthesis
/ surgery
Male
Female
Aged
Quality of Life
Middle Aged
Healthcare Disparities
/ statistics & numerical data
Lumbar Vertebrae
/ surgery
Cohort Studies
United States
Ethnicity
/ statistics & numerical data
Treatment Outcome
Low Back Pain
/ surgery
Prospective Studies
Socioeconomic Factors
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 Sep 2024
01 Sep 2024
Historique:
received:
06
09
2023
accepted:
11
01
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
15
8
2024
Statut:
ppublish
Résumé
Racial and socioeconomic disparities in spine surgery for degenerative lumbar spondylolisthesis persist in the United States, potentially contributing to unequal health-related quality of life (HRQoL) outcomes. This is important as lumbar spondylolisthesis is one of the most common causes of surgical low back pain, and low back pain is the largest disabler of individuals worldwide. Our objective was to assess the relationship between race, socioeconomic factors, treatment utilization, and outcomes in patients with lumbar spondylolisthesis. This cohort study analyzed prospectively collected data from 9941 patients diagnosed with lumbar spondylolisthesis between 2015 and 2020 at 5 academic hospitals. Exposures were race, socioeconomic status, health coverage, and HRQoL measures. Main outcomes and measures included treatment utilization rates between racial groups and the association between race and treatment outcomes using logistic regression, adjusting for patient characteristics, socioeconomic status, health coverage, and HRQoL measures. Of the 9941 patients included (mean [SD] age, 67.37 [12.40] years; 63% female; 1101 [11.1%] Black, Indigenous, and People of Color [BIPOC]), BIPOC patients were significantly less likely to use surgery than White patients (odds ratio [OR] = 0.68; 95% CI, 0.62-0.75). Furthermore, BIPOC race was associated with significantly lower odds of reaching the minimum clinically important difference for physical function (OR = 0.74; 95% CI, 0.60; 0.91) and pain interference (OR = 0.77; 95% CI, 0.62-0.97). Medicaid beneficiaries were significantly less likely (OR = 0.65; 95% CI, 0.46-0.92) to reach a clinically important improvement in HRQoL when accounting for race. This study found that BIPOC patients were less likely to use spine surgery for degenerative lumbar spondylolisthesis despite reporting higher pain interference, suggesting an association between race and surgical utilization. These disparities may contribute to unequal HRQoL outcomes for patients with lumbar spondylolisthesis and warrant further investigation to address and reduce treatment disparities.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Racial and socioeconomic disparities in spine surgery for degenerative lumbar spondylolisthesis persist in the United States, potentially contributing to unequal health-related quality of life (HRQoL) outcomes. This is important as lumbar spondylolisthesis is one of the most common causes of surgical low back pain, and low back pain is the largest disabler of individuals worldwide. Our objective was to assess the relationship between race, socioeconomic factors, treatment utilization, and outcomes in patients with lumbar spondylolisthesis.
METHODS
METHODS
This cohort study analyzed prospectively collected data from 9941 patients diagnosed with lumbar spondylolisthesis between 2015 and 2020 at 5 academic hospitals. Exposures were race, socioeconomic status, health coverage, and HRQoL measures. Main outcomes and measures included treatment utilization rates between racial groups and the association between race and treatment outcomes using logistic regression, adjusting for patient characteristics, socioeconomic status, health coverage, and HRQoL measures.
RESULTS
RESULTS
Of the 9941 patients included (mean [SD] age, 67.37 [12.40] years; 63% female; 1101 [11.1%] Black, Indigenous, and People of Color [BIPOC]), BIPOC patients were significantly less likely to use surgery than White patients (odds ratio [OR] = 0.68; 95% CI, 0.62-0.75). Furthermore, BIPOC race was associated with significantly lower odds of reaching the minimum clinically important difference for physical function (OR = 0.74; 95% CI, 0.60; 0.91) and pain interference (OR = 0.77; 95% CI, 0.62-0.97). Medicaid beneficiaries were significantly less likely (OR = 0.65; 95% CI, 0.46-0.92) to reach a clinically important improvement in HRQoL when accounting for race.
CONCLUSION
CONCLUSIONS
This study found that BIPOC patients were less likely to use spine surgery for degenerative lumbar spondylolisthesis despite reporting higher pain interference, suggesting an association between race and surgical utilization. These disparities may contribute to unequal HRQoL outcomes for patients with lumbar spondylolisthesis and warrant further investigation to address and reduce treatment disparities.
Identifiants
pubmed: 39145650
doi: 10.1227/neu.0000000000002925
pii: 00006123-202409000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
576-583Informations de copyright
Copyright © Congress of Neurological Surgeons 2024. All rights reserved.
Références
Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am. 2019;30(3):299-304.
Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine. 2009;34(2):199-205.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296(20):2441-2450.
Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021;385(6):526-538.
Carey TS, Freburger JK, Holmes GM, et al. Race, care seeking, and utilization for chronic back and neck pain: population perspectives. J Pain. 2010;11(4):343-350.
Carey TS, Garrett JM. The relation of race to outcomes and the use of health care services for acute low back pain. Spine. 2003;28(4):390-394.
Chan AK, Letchuman V, Mummaneni PV, et al. 403 inferior clinical outcomes for patients with medicaid insurance following surgery for degenerative lumbar spondylolisthesis: a prospective registry analysis of 608 patients. Neurosurgery. 2023;69(Supplement_1):75-76.
Sanford Z, Taylor H, Fiorentino A, et al. Racial disparities in surgical outcomes after spine surgery: an ACS-NSQIP analysis. Glob Spine J. 2019;9(6):583-590.
Lad SP, Huang KT, Bagley JH, et al. Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status. Spine. 2013;38(13):1119-1127.
Jancuska JM, Hutzler L, Protopsaltis TS, Bendo JA, Bosco J. Utilization of lumbar spinal fusion in New York State: trends and disparities. Spine. 2016;41(19):1508-1514.
Crawford AM, Xiong GX, Lightsey HM, et al. Insurance type is associated with baseline patient-reported outcome measures in patients with lumbar stenosis. Spine. 2022;47(10):737-744.
Khan IS, Huang E, Maeder-York W, et al. Racial disparities in outcomes after spine surgery: a systematic review and meta-analysis. World Neurosurg. 2022;157:e232-e244.
Van Buuren S, Groothuis-Oudshoorn K. Mice: Multivariate Imputation by Chained Equations in R J Stat Softw. 2011;45(3):1-67.
Obama B. United States health care reform: progress to date and next steps. JAMA. 2016;316(5):525-532.
Engler ID, Vasavada KD, Vanneman ME, Schoenfeld AJ, Martin BI. Do community-level disadvantages account for racial disparities in the safety of spine surgery? A large database study based on medicare claims. Clin Orthop Relat Res. 2023;481(2):268-278.
Ladin K, Lin N, Hahn E, Zhang G, Koch-Weser S, Weiner DE. Engagement in decision-making and patient satisfaction: a qualitative study of older patients' perceptions of dialysis initiation and modality decisions. Nephrol Dial Transpl. 2017;32(8):1394-1401.
Wang MY, Chang PY, Grossman J. Development of an Enhanced Recovery after Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411-418.
Chan AK, Letchuman V, Mummaneni PV, et al. Inferior clinical outcomes for patients with medicaid insurance after surgery for degenerative lumbar spondylolisthesis: a prospective registry analysis of 608 patients. World Neurosurg. 2022;164:e1024-e1033.
Bronson WH, Kingery MT, Hutzler L, et al. Lack of cost savings for lumbar spine fusions after bundled payments for care improvement initiative: a consequence of increased case complexity. Spine. 2019;44(4):298-304.
Martin BI, Lurie JD, Farrokhi FR, McGuire KJ, Mirza SK. Early effects of medicare's bundled payment for care improvement program for lumbar fusion. Spine. 2018;43(10):705-711.
Karhade AV, Fogel HA, Cha TD, et al. Development of prediction models for clinically meaningful improvement in PROMIS scores after lumbar decompression. Spine J. 2021;21(3):397-404.
Sedaghat AR. Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures. Otolaryngol Head Neck Surg. 2019;161(4):551-560.