Abstract：
BACKGROUND: In mild to moderate lumbar spinal stenosis (LSS) where conservative care treatments fail, minimally invasive treatments, such as interspinous spacers without decompression or fusion (ISD), may be appropriate. While previous studies have demonstrated racial and socioeconomic disparities in the surgical treatment of LSS, there are limited data on how those factors impact accessibility to these procedures. This study explored demographic, socioeconomic, and geographic differences in the use of ISD.
METHODS: Using the Medicare 100% files from 2017 through 2022, this retrospective claims analysis identified when and if patients diagnosed with LSS received ISD implantation. Cox proportional hazards regression was used to examine the association between racial and socioeconomic characteristics and the rate of ISD implantation, stratified by geographic region.
RESULTS: A total of 1,316,622 individuals met the inclusion criteria; 4730 (0.4%) underwent ISD implantation, with a mean (standard deviation) time to treatment of 11.9 (13.2) months after diagnosis. The likelihood of ISD implantation was higher for older patients (except for the oldest group), males, those with lower disease burden, and White patients. Cox regression revealed that the associations of racial and socioeconomic factors with ISD implantation varied by U.S. region. In the Midwest and Northeast, lower median household income was associated with a decreased likelihood of ISD implantation regardless of race, while in the South, Black patients were less likely to undergo ISD implantation regardless of income.
CONCLUSIONS: The observed disparities in access to ISD implantation mirror existing trends in surgical interventions for LSS, suggesting further study and interventions are needed to address inequities.
METHODS: Using the Medicare 100% files from 2017 through 2022, this retrospective claims analysis identified when and if patients diagnosed with LSS received ISD implantation. Cox proportional hazards regression was used to examine the association between racial and socioeconomic characteristics and the rate of ISD implantation, stratified by geographic region.
RESULTS: A total of 1,316,622 individuals met the inclusion criteria; 4730 (0.4%) underwent ISD implantation, with a mean (standard deviation) time to treatment of 11.9 (13.2) months after diagnosis. The likelihood of ISD implantation was higher for older patients (except for the oldest group), males, those with lower disease burden, and White patients. Cox regression revealed that the associations of racial and socioeconomic factors with ISD implantation varied by U.S. region. In the Midwest and Northeast, lower median household income was associated with a decreased likelihood of ISD implantation regardless of race, while in the South, Black patients were less likely to undergo ISD implantation regardless of income.
CONCLUSIONS: The observed disparities in access to ISD implantation mirror existing trends in surgical interventions for LSS, suggesting further study and interventions are needed to address inequities.
摘要：
背景：在保守治疗失败的轻度至中度腰椎管狭窄症（LSS）中，微创治疗,例如没有减压或融合（ISD）的棘突间间隔物，可能是合适的。虽然以前的研究表明，在LSS的手术治疗中存在种族和社会经济差异，关于这些因素如何影响这些程序的可及性的数据有限。这项研究探讨了人口学，社会经济,以及ISD使用的地理差异。
方法：使用2017年至2022年的Medicare100％文件，这项回顾性调查分析确定了诊断为LSS的患者何时以及是否接受了ISD植入。Cox比例风险回归用于检查种族和社会经济特征与ISD植入率之间的关系。按地理区域分层。
结果：共有1,316,622人符合纳入标准；4730人（0.4%）接受了ISD植入，诊断后治疗的平均时间（标准差）为11.9（13.2）个月。老年患者植入ISD的可能性更高（年龄最大的患者除外），男性,那些疾病负担较低的人，白人患者Cox回归显示，种族和社会经济因素与ISD植入的关联因美国地区而异。在中西部和东北部，较低的家庭收入中位数与ISD植入的可能性降低相关，无论种族如何，而在南方,无论收入如何，黑人患者不太可能接受ISD植入。
结论：观察到的ISD植入的差异反映了LSS手术干预的现有趋势，建议需要进一步的研究和干预措施来解决不平等问题。
方法：使用2017年至2022年的Medicare100％文件，这项回顾性调查分析确定了诊断为LSS的患者何时以及是否接受了ISD植入。Cox比例风险回归用于检查种族和社会经济特征与ISD植入率之间的关系。按地理区域分层。
结果：共有1,316,622人符合纳入标准；4730人（0.4%）接受了ISD植入，诊断后治疗的平均时间（标准差）为11.9（13.2）个月。老年患者植入ISD的可能性更高（年龄最大的患者除外），男性,那些疾病负担较低的人，白人患者Cox回归显示，种族和社会经济因素与ISD植入的关联因美国地区而异。在中西部和东北部，较低的家庭收入中位数与ISD植入的可能性降低相关，无论种族如何，而在南方,无论收入如何，黑人患者不太可能接受ISD植入。
结论：观察到的ISD植入的差异反映了LSS手术干预的现有趋势，建议需要进一步的研究和干预措施来解决不平等问题。
