Abstract：
OBJECTIVE: Although studies have described inequities in spinal cord stimulation (SCS) receipt, there is a lack of information to inform system-level changes to support health care equity. This study evaluated whether Black patients exhaust more treatment options than do White patients, before receiving SCS.
METHODS: This retrospective cohort study included claims data of Black and non-Latinx White patients who were active-duty service members or military retirees who received a persistent spinal pain syndrome (PSPS) diagnosis associated with back surgery within the US Military Health System, January 2017 to January 2020 (N = 8753). A generalized linear model examined predictors of SCS receipt within two years of diagnosis, including the interaction between race and number of pain-treatment types received.
RESULTS: In the generalized linear model, Black patients (10.3% [8.7%, 12.0%]) were less likely to receive SCS than were White patients (13.6% [12.7%, 14.6%]) The interaction term was significant; White patients who received zero to three different types of treatments were more likely to receive SCS than were Black patients who received zero to three treatments, whereas Black and White patients who received >three treatments had similar likelihoods of receiving a SCS.
CONCLUSIONS: In a health care system with intended universal access, White patients diagnosed with PSPS tried fewer treatment types before receiving SCS, whereas the number of treatment types tried was not significantly related to SCS receipt in Black patients. Overall, Black patients received SCS less often than did White patients. Findings indicate the need for structured referral pathways, provider evaluation on equity metrics, and top-down support.
METHODS: This retrospective cohort study included claims data of Black and non-Latinx White patients who were active-duty service members or military retirees who received a persistent spinal pain syndrome (PSPS) diagnosis associated with back surgery within the US Military Health System, January 2017 to January 2020 (N = 8753). A generalized linear model examined predictors of SCS receipt within two years of diagnosis, including the interaction between race and number of pain-treatment types received.
RESULTS: In the generalized linear model, Black patients (10.3% [8.7%, 12.0%]) were less likely to receive SCS than were White patients (13.6% [12.7%, 14.6%]) The interaction term was significant; White patients who received zero to three different types of treatments were more likely to receive SCS than were Black patients who received zero to three treatments, whereas Black and White patients who received >three treatments had similar likelihoods of receiving a SCS.
CONCLUSIONS: In a health care system with intended universal access, White patients diagnosed with PSPS tried fewer treatment types before receiving SCS, whereas the number of treatment types tried was not significantly related to SCS receipt in Black patients. Overall, Black patients received SCS less often than did White patients. Findings indicate the need for structured referral pathways, provider evaluation on equity metrics, and top-down support.
摘要：
目的：尽管研究已经描述了脊髓刺激（SCS）接收的不公平，缺乏信息来告知系统级别的变化以支持医疗保健公平。这项研究评估了黑人患者是否比白人患者消耗更多的治疗方案，在接收SCS之前。
方法：这项回顾性队列研究包括黑人和非拉丁裔白人患者的索赔数据，这些患者是现役军人或军事退休人员，他们在美国军事卫生系统内接受了与背部手术相关的持续性脊柱疼痛综合征（PSPS）诊断，2017年1月至2020年1月（N=8753）。广义线性模型检查了诊断后两年内SCS接收的预测因素，包括种族和接受疼痛治疗类型的数量之间的相互作用。
结果：在广义线性模型中，黑人患者(10.3%[8.7%，12.0%])与白人患者(13.6%[12.7%，14.6%])交互项显著；接受零至三种不同类型治疗的白人患者比接受零至三种治疗的黑人患者更可能接受SCS，而接受超过3种治疗的黑人和白人患者接受SCS的可能性相似。
结论：在预期普及的医疗保健系统中，诊断为PSPS的白人患者在接受SCS之前尝试了较少的治疗类型，而Black患者尝试的治疗类型数量与接受SCS治疗无显著相关.总的来说,黑人患者接受SCS的频率低于白人患者。研究结果表明需要结构化的转诊途径，提供商对权益指标的评估，自上而下的支持。
方法：这项回顾性队列研究包括黑人和非拉丁裔白人患者的索赔数据，这些患者是现役军人或军事退休人员，他们在美国军事卫生系统内接受了与背部手术相关的持续性脊柱疼痛综合征（PSPS）诊断，2017年1月至2020年1月（N=8753）。广义线性模型检查了诊断后两年内SCS接收的预测因素，包括种族和接受疼痛治疗类型的数量之间的相互作用。
结果：在广义线性模型中，黑人患者(10.3%[8.7%，12.0%])与白人患者(13.6%[12.7%，14.6%])交互项显著；接受零至三种不同类型治疗的白人患者比接受零至三种治疗的黑人患者更可能接受SCS，而接受超过3种治疗的黑人和白人患者接受SCS的可能性相似。
结论：在预期普及的医疗保健系统中，诊断为PSPS的白人患者在接受SCS之前尝试了较少的治疗类型，而Black患者尝试的治疗类型数量与接受SCS治疗无显著相关.总的来说,黑人患者接受SCS的频率低于白人患者。研究结果表明需要结构化的转诊途径，提供商对权益指标的评估，自上而下的支持。
