The Impact of Racial and Low Socioeconomic Status on the Implementation of Spinal Cord Stimulation for Chronic Pain in the United States.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY

Current Pain and Headache Reports Pub Date : 2025-01-30 DOI:10.1007/s11916-024-01315-6

Gabriel Howard, Luis Guinand, Eric Xu, Alex Kervyn, Behnum Habibi

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Abstract

Objectives: This study aims to review the societal, economic, and racial factors that impact the usage of spinal cord stimulation for chronic pain. Our working hypothesis is that patients of ethnic minority groups or of lower socioeconomic status (SES) status may have lower implantation rates and usage of spinal cord stimulation (SCS).

Materials and methods: Our study sourced publications from PubMed, Embase, and Cochrane Library on December 21st, 2023 for SCS for the purposes of pain management. Articles were excluded from the review if the study was not USA based, did not involve SCS for the purpose of pain or did not allow for the subgroup analysis. There were 1028 reports that resulted after the initial search with 184 duplicates which were removed. Six reports met the inclusion and exclusionary criteria and were included in the review.

Results: Several trends were able to be extrapolated from the pooled reviews. Orhurhu et al. found that Black and Hispanic minorities had a higher utilization rate of SCSs than their White and Asian counterparts in the inpatient setting. Jones and Missios et al. found that in the outpatient setting, White and privately insured patients were more likely to utilize SCS. Ovrom et al. observed an increased cost associated with Hispanic ethnicity and inpatient SCS utilization. Wondwossen et al. found that in the US military system White patients were more likely to receive SCS earlier in their care than Black patients. Labaran et al. concluded the Southern US completed more SCS implants, particularly in White patients with Medicare insurance.

Conclusions: White patients are recipients of SCS earlier and more frequently than minority patients in the outpatient setting. There is mixed evidence regarding inpatient SCS and how household income relates to SCS usage. Insurance type and coverage may be more accurately predictive than simple household income for SCS utilization.

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种族和低社会经济地位对美国实施脊髓刺激治疗慢性疼痛的影响。

目的：本研究旨在回顾影响脊髓刺激治疗慢性疼痛的社会、经济和种族因素。我们的工作假设是少数民族或社会经济地位（SES）地位较低的患者可能有较低的植入率和脊髓刺激（SCS）的使用。材料和方法：我们的研究来源于PubMed， Embase和Cochrane图书馆于2023年12月21日发表的用于疼痛管理的SCS。如果研究不是在美国进行的，不涉及以疼痛为目的的SCS或不允许进行亚组分析，则文章被排除在综述之外。在最初的搜索之后，产生了1028份报告，其中184份重复的报告被删除了。6份报告符合纳入和排除标准，并被纳入审查。结果：从汇总的综述中可以推断出几个趋势。Orhurhu等人发现，在住院环境中，黑人和西班牙裔少数民族比白人和亚洲人对社会服务系统的使用率更高。Jones和Missios等人发现，在门诊环境中，怀特和私人保险患者更有可能使用SCS。Ovrom等人观察到西班牙裔与住院患者SCS使用相关的成本增加。Wondwossen等人发现，在美国军事系统中，白人患者比黑人患者更有可能在护理早期接受SCS。Labaran等人得出结论，美国南部完成了更多的SCS植入，特别是在有医疗保险的白人患者中。结论：在门诊，白人患者比少数民族患者更早、更频繁地接受SCS。关于住院患者的SCS以及家庭收入与SCS使用的关系，有不同的证据。保险类型和覆盖范围可能比简单的家庭收入更准确地预测SCS的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Pain and Headache Reports CLINICAL NEUROLOGY-

CiteScore

6.10

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.