Racial, ethnic and socioeconomic disparities in healthcare for adult spinal deformity patients.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-05-28 DOI:10.1007/s43390-025-01118-8

Joseph E Nassar, Michael J Farias, Manjot Singh, Andrew Xu, Lama A Ammar, Mohammad Daher, Ashley Knebel, Bassel G Diebo, Alan H Daniels

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引用次数: 0

Abstract

Background: Racial and ethnic disparities in healthcare access remain underexplored among adult spinal deformity (ASD) patients in terms of cost related and non-cost related barriers to care.

Methods: This cross-sectional study analyzed healthcare access and utilization survey data from the National Institutes of Health's All of Us Research Program (May 6th, 2018-January 30th, 2025). The participants included adults aged ≥ 40 years with spinal deformity enrolled online or through partner organizations across the US. The cost and non-cost barriers to health among ASD patients by race and ethnicity were reported. Multivariate logistic regressions were used to analyze the relationship between race and ethnicity and experiencing barriers to care.

Results: This study included 7272 ASD patients of which 5635 were White (74.5%) (median age, 69 years [IQR, 60.0-75.0]), 535 Hispanic (7.4%) (60.0 years [51.0-68.0]), 538 (7.4%) Black (61.5 years [52.0-69.0]) and 564 (7.8%) of other race and ethnicity (65.0 years [55.0-74.0]) of whom 528 (7.3%) proceeded to undergo correction surgery. Compared to White patients, Black patients had higher odds of reporting delayed general care (adjusted odds ratio [aOR, 2.5; 95% CI 1.7-3.8), follow-up care (aOR, 1.6; 95% CI 1.1-2.3), and prescription filling (aOR, 1.5; 95% CI 1.1-1.9) due to cost. Non-cost barriers for Black patients included lack of transportation aOR, 3.2; 95% CI 2.3-4.3) while Hispanic patients had higher odds of reporting delayed care due to childcare (aOR, 2.9; 95% CI 1.5-5.5) and care to an adult (aOR, 1.8; 95% CI 1.0-3.3) responsibilities. Black and Hispanic patients had higher odds of placing importance on having a provider with a similar background (aOR, 2.4; 95% CI 1.9-3.0; aOR, 3.1, 95% CI 2.4-3.9) and of never having had such a provider (aOR, 4.6; 95% CI 3.2-6.6; aOR, 3.1, 95% CI 2.4-3.9), respectively. They also had higher odds of reporting delayed care due to provider background differences (aOR, 1.9, 95% CI 1.4-2.4; aOR, 1.6, 95% CI 1.2-2.2), respectively. Additionally, Hispanic patients had higher odds of reporting not being treated with respect by their provider (aOR, 1.6; 95% CI 1.0-2.5).

Conclusions: Racial and ethnic disparities significantly impact ASD patients with Hispanic and Black patients facing higher rates of cost and non-cost barriers to care. The healthcare practitioners especially those specializing in ASD play a crucial role in recognizing and addressing these disparities to improve healthcare access and outcomes across racial and ethnic groups.

Level of evidence: Prognostic Level III.

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成人脊柱畸形患者医疗保健中的种族、民族和社会经济差异

背景：就成本相关和非成本相关的护理障碍而言，成人脊柱畸形（ASD）患者在医疗保健获取方面的种族和民族差异仍未得到充分研究。方法：本横断面研究分析了美国国立卫生研究院“我们所有人”研究计划（2018年5月6日至2025年1月30日）的医疗保健获取和利用调查数据。参与者包括年龄≥40岁的脊柱畸形成年人，他们通过在线或通过美国各地的合作组织注册。报告了不同种族和民族的ASD患者健康的成本和非成本障碍。采用多变量logistic回归分析种族和民族与护理障碍之间的关系。结果：本研究纳入7272例ASD患者，其中白人5635例（74.5%）（中位年龄69岁[IQR， 60.0-75.0]），西班牙裔535例（7.4%）（60.0岁[51.0-68.0]），黑人538例（7.4%）（61.5岁[52.0-69.0]），其他种族564例（7.8%）（65.0岁[55.0-74.0]），其中528例（7.3%）接受了矫正手术。与白人患者相比，黑人患者报告延迟一般护理的几率更高(调整优势比[aOR， 2.5；95% CI 1.7-3.8)，随访护理(aOR, 1.6；95% CI 1.1-2.3)和处方填充(aOR, 1.5；95% CI 1.1-1.9)，原因是成本。黑人患者的非成本障碍包括缺少交通工具（or）， 3.2；95% CI 2.3-4.3)，而西班牙裔患者报告因儿童保育而延迟护理的几率更高(aOR, 2.9；95% CI 1.5-5.5)和成人护理(aOR, 1.8；95% CI 1.0-3.3)责任。黑人和西班牙裔患者更重视拥有相似背景的医疗服务提供者(aOR, 2.4；95% ci 1.9-3.0；aOR, 3.1, 95% CI 2.4-3.9)和从未有过这样的提供者(aOR, 4.6；95% ci 3.2-6.6；aOR为3.1,95% CI为2.4-3.9)。由于提供者背景差异，他们报告延迟护理的几率也更高(aOR, 1.9, 95% CI 1.4-2.4；aOR为1.6,95% CI为1.2-2.2)。此外，西班牙裔患者报告没有得到提供者尊重的几率更高(aOR, 1.6；95% ci 1.0-2.5)。结论：种族和民族差异显著影响西班牙裔和黑人ASD患者面临更高的成本和非成本护理障碍。医疗保健从业人员，特别是那些专门从事自闭症谱系障碍的人，在认识和解决这些差异以改善跨种族和族裔群体的医疗保健机会和结果方面发挥着至关重要的作用。证据等级：预后III级。

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

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.