Title: Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background
Country: United States
Age: Adult Only
Sex: All Sexes
Population: Multiple Groups
Care Setting: Outpatient Ambulatory and Primary Care
Clinical Setting: Back Pain Imaging
Data Level: National
Data Type: Disease Registry
Data Source: National registry
Conclusion: Disparities In All Minority Groups
Health OutComes Reported: No
Free Text Conclusion: Minorities less likely to have imaging ordered as part of low back pain work up in outpatient setting.
Abstract: Study Design: Retrospective review comparing physician workup of degenerative lumbosacral pathologies between different genders and ethnic groups. Objectives: To investigate whether patient ethnicity and gender influence the workup and treatment of degenerative spinal pathologies. Summary of Background Data: Data from numerous studies suggest that patient gender and ethnicity play a role in medical decision-making, with white males receiving more frequent interventions than women and minorities. Methods: Patients enrolled for an "initial visit" in the National Spine Network database with lumbosacral level degenerative diagnosis were reviewed. Variables included patient gender, ethnicity, age, duration of symptoms, patient-graded severity of symptoms, radicular symptom pattern, and work status. Results: We identified 5690 patients with degenerative lumbosacral pathologies. Although females were more likely than males to have imaging tests ordered, male (18.5%) patients were significantly more likely to have surgery recommended than female (16.3%) patients (P < 0.031). Nonwhite females were 52% less likely to have surgery offered at initial visit, as compared to white males (P < 0.005). More imaging tests were ordered or reviewed among whites (76.6%) than among any other ethnic group (P = 0.162). White (18.3%) and Asian (22.5%) patients were significantly more likely to have surgery recommended or prescribed than black (11.1%) and Hispanic (14.5) patients (P < 0.0001). Conclusions: This study suggests that ethnicity and gender affect the workup and surgical management of degenerative spinal disorders. However, it should be noted that there are a number of confounding factors not identified in the database, including managed care and insurance status and cultural differences, which may affect both test ordering and treatment recommendations. Further study of bias in clinical decision-making is indicated to assure equal delivery of quality care.