Associations of Race and Ethnicity With Patient-Reported Outcomes and Health Care Utilization Among Older Adults Initiating a New Episode of Care for Back Pain. Issue 14 (15th July 2018)

• Record Type: Journal Article
• Authors: Milani, Carlo J.; Rundell, Sean D.; Jarvik, Jeffrey G.; Friedly, Janna; Heagerty, Patrick J.; Avins, Andy; Nerenz, David; Gold, Laura S.; Turner, Judith A.; Annaswamy, Thiru; Nedeljkovic, Srdjan S.; Suri, Pradeep
• Is Part Of: Spine. Volume 43:Issue 14(2018)
• Publication Date: 2018-07-15
• Subjects: Asian -- black -- disability -- disparity -- ethnicity -- functional limitation -- Hispanic -- low back pain -- older adults -- race -- utilization; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000002499
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. Objective: To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for BP. Summary of Background Data: No prior longitudinal studies have characterized associations between multiple race/ethnicity groups, and BP-related PROs and health care utilization in the United States. Methods: This study included 5117 participants ≥65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site. Results: Baseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P < 0.001). Participants in all race/ethnicity groups showed statistically significant, but modest improvements in BP over 24 months. Blacks and Hispanics did not have statistically significant improvement in BP-related functional limitations over time, unlike whites, Asians, and non-Hispanics; however, the magnitude of differences in improvement between groups was small. Blacks had less spine-related health care utilization over 24 months than whites (spine-related RVU ratio of means 0.66, 95% confidence interval [CI] 0.51–0.86). Hispanics had less spine-related health care utilization than non-Hispanics (spine-related RVU ratio of means 0.60; 95% CI 0.40–0.90). Conclusion: Blacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. Residual confounding may explain some of the association between race/ethnicity and health outcomes. Further studies are needed to understand the factors underlying these differences and which differences reflect disparities. Level of Evidence: 3 Abstract : Supplemental Digital Content is available in the text