Association of neighborhood deprivation with pain, function, and disability recovery trajectories following cervical spine surgery.

Abstract

Objective: Although neighborhood deprivation has been shown to predict complications and readmissions, its association with pain, disability, and function in degenerative cervical spine disease has not been demonstrated. The aim of this study was to investigate the association between the Area Deprivation Index (ADI) and patient-reported outcome measures (PROMs) preoperatively and 3, 6, and 12 months postoperatively.

Methods: This was a secondary analysis of a single-center prospectively collected database of patients who underwent elective cervical spine surgery from January 2021 to September 2024. PROMs included the Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Health physical and mental health domains, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Neighborhood disadvantage was assessed via the ADI, with higher values indicating greater deprivation. Outcomes were assessed at preoperative and 3-, 6-, and 12-month postoperative time points. The minimal clinically important difference (MCID) was assessed at each time point. Missing data were handled with imputation. Unadjusted comparisons and 1-way ANOVA were used to evaluate differences in PROMs across ADI quartiles, and multivariable adjusted linear regression models were used to evaluate the association between ADI and PROMs.

Results: There were 449 patients (mean age 57.9 years) included in this analysis. Patients in higher ADI quartiles of deprivation reported significantly worse preoperative pain, disability, and health-related quality of life, with higher NRS neck and arm pain scores and NDI scores, and lower PROMIS physical and mental health domain scores (p ≤ 0.005). These disparities persisted at 3 and 6 months postoperatively, with patients in the highest deprivation quartile demonstrating worse pain, disability, and PROMIS outcomes compared with those in lower quartiles (p < 0.01). However, this difference was no longer seen by 12 months. In the multivariable regression analysis, high deprivation independently predicted worse baseline PROMs and reduced improvement in pain, disability, and PROMIS physical function at 3 and 6 months after surgery, although this association did not persist at 12 months. Deprivation was inconsistently associated with achieving the MCID, with lower odds for the NDI, NRS for arm pain, and PROMIS domains at early time points but without persisting disadvantage at 12 months.

Conclusions: Higher levels of deprivation according to the ADI were associated with worse preoperative disease severity and worse quality of life and function during early recovery, but with improvements at later time points. Patients with greater socioeconomic deprivation can derive significant benefit from surgical intervention for degenerative cervical spine conditions.