Abstract：
OBJECTIVE: Racial and socioeconomic disparities in spine surgery for degenerative lumbar spondylolisthesis persist in the United States, potentially contributing to unequal health-related quality of life (HRQoL) outcomes. This is important as lumbar spondylolisthesis is one of the most common causes of surgical low back pain, and low back pain is the largest disabler of individuals worldwide. Our objective was to assess the relationship between race, socioeconomic factors, treatment utilization, and outcomes in patients with lumbar spondylolisthesis.
METHODS: This cohort study analyzed prospectively collected data from 9941 patients diagnosed with lumbar spondylolisthesis between 2015 and 2020 at 5 academic hospitals. Exposures were race, socioeconomic status, health coverage, and HRQoL measures. Main outcomes and measures included treatment utilization rates between racial groups and the association between race and treatment outcomes using logistic regression, adjusting for patient characteristics, socioeconomic status, health coverage, and HRQoL measures.
RESULTS: Of the 9941 patients included (mean [SD] age, 67.37 [12.40] years; 63% female; 1101 [11.1%] Black, Indigenous, and People of Color [BIPOC]), BIPOC patients were significantly less likely to use surgery than White patients (odds ratio [OR] = 0.68; 95% CI, 0.62-0.75). Furthermore, BIPOC race was associated with significantly lower odds of reaching the minimum clinically important difference for physical function (OR = 0.74; 95% CI, 0.60; 0.91) and pain interference (OR = 0.77; 95% CI, 0.62-0.97). Medicaid beneficiaries were significantly less likely (OR = 0.65; 95% CI, 0.46-0.92) to reach a clinically important improvement in HRQoL when accounting for race.
CONCLUSIONS: This study found that BIPOC patients were less likely to use spine surgery for degenerative lumbar spondylolisthesis despite reporting higher pain interference, suggesting an association between race and surgical utilization. These disparities may contribute to unequal HRQoL outcomes for patients with lumbar spondylolisthesis and warrant further investigation to address and reduce treatment disparities.
METHODS: This cohort study analyzed prospectively collected data from 9941 patients diagnosed with lumbar spondylolisthesis between 2015 and 2020 at 5 academic hospitals. Exposures were race, socioeconomic status, health coverage, and HRQoL measures. Main outcomes and measures included treatment utilization rates between racial groups and the association between race and treatment outcomes using logistic regression, adjusting for patient characteristics, socioeconomic status, health coverage, and HRQoL measures.
RESULTS: Of the 9941 patients included (mean [SD] age, 67.37 [12.40] years; 63% female; 1101 [11.1%] Black, Indigenous, and People of Color [BIPOC]), BIPOC patients were significantly less likely to use surgery than White patients (odds ratio [OR] = 0.68; 95% CI, 0.62-0.75). Furthermore, BIPOC race was associated with significantly lower odds of reaching the minimum clinically important difference for physical function (OR = 0.74; 95% CI, 0.60; 0.91) and pain interference (OR = 0.77; 95% CI, 0.62-0.97). Medicaid beneficiaries were significantly less likely (OR = 0.65; 95% CI, 0.46-0.92) to reach a clinically important improvement in HRQoL when accounting for race.
CONCLUSIONS: This study found that BIPOC patients were less likely to use spine surgery for degenerative lumbar spondylolisthesis despite reporting higher pain interference, suggesting an association between race and surgical utilization. These disparities may contribute to unequal HRQoL outcomes for patients with lumbar spondylolisthesis and warrant further investigation to address and reduce treatment disparities.
摘要：
目的：在美国，退行性腰椎滑脱的脊柱手术中种族和社会经济差异仍然存在，可能导致不平等的健康相关生活质量（HRQoL）结果。这一点很重要，因为腰椎滑脱是手术下腰痛的最常见原因之一，腰背痛是全球最大的禁用者。我们的目标是评估种族之间的关系，社会经济因素,处理利用，腰椎滑脱患者的预后。
方法：这项队列研究分析了2015年至2020年在5家学术医院诊断为腰椎滑脱的9941例患者的前瞻性数据。暴露是种族，社会经济地位,健康保险,和HRQoL措施。主要结果和措施包括种族群体之间的治疗利用率以及种族和治疗结果之间的关联使用逻辑回归，根据患者特征进行调整，社会经济地位,健康保险,和HRQoL措施。
结果：在9941例患者中（平均[SD]年龄，67.37[12.40]岁；63%为女性；1101[11.1%]黑人，土著,和有色人种[BIPOC])，BIPOC患者使用手术的可能性明显低于白人患者（比值比[OR]=0.68；95％CI，0.62-0.75）。此外，BIPOC种族与身体功能（OR=0.74;95％CI，0.60;0.91）和疼痛干扰（OR=0.77;95％CI，0.62-0.97）达到最小临床重要差异的几率显着降低。考虑到种族，医疗补助受益人在HRQoL方面达到临床重要改善的可能性显着降低（OR=0.65；95％CI，0.46-0.92）。
结论：这项研究发现，尽管有较高的疼痛干扰，BIPOC患者使用脊柱手术治疗退行性腰椎滑脱的可能性较小，表明种族和手术使用之间的联系。这些差异可能导致腰椎滑脱患者的HRQoL结果不平等，需要进一步研究以解决和减少治疗差异。
方法：这项队列研究分析了2015年至2020年在5家学术医院诊断为腰椎滑脱的9941例患者的前瞻性数据。暴露是种族，社会经济地位,健康保险,和HRQoL措施。主要结果和措施包括种族群体之间的治疗利用率以及种族和治疗结果之间的关联使用逻辑回归，根据患者特征进行调整，社会经济地位,健康保险,和HRQoL措施。
结果：在9941例患者中（平均[SD]年龄，67.37[12.40]岁；63%为女性；1101[11.1%]黑人，土著,和有色人种[BIPOC])，BIPOC患者使用手术的可能性明显低于白人患者（比值比[OR]=0.68；95％CI，0.62-0.75）。此外，BIPOC种族与身体功能（OR=0.74;95％CI，0.60;0.91）和疼痛干扰（OR=0.77;95％CI，0.62-0.97）达到最小临床重要差异的几率显着降低。考虑到种族，医疗补助受益人在HRQoL方面达到临床重要改善的可能性显着降低（OR=0.65；95％CI，0.46-0.92）。
结论：这项研究发现，尽管有较高的疼痛干扰，BIPOC患者使用脊柱手术治疗退行性腰椎滑脱的可能性较小，表明种族和手术使用之间的联系。这些差异可能导致腰椎滑脱患者的HRQoL结果不平等，需要进一步研究以解决和减少治疗差异。
