Associations of Race and Ethnicity With Patient-Reported Outcomes and Health Care Utilization Among Older Adults Initiating a New Episode of Care for Back Pain

Spine (Phila Pa 1976). 2018 Jul 15;43(14):1007-1017. doi: 10.1097/BRS.0000000000002499.

Abstract

Study design: Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study.

Objective: To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for BP.

Summary of background data: No prior longitudinal studies have characterized associations between multiple race/ethnicity groups, and BP-related PROs and health care utilization in the United States.

Methods: This study included 5117 participants ≥65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site.

Results: Baseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P < 0.001). Participants in all race/ethnicity groups showed statistically significant, but modest improvements in BP over 24 months. Blacks and Hispanics did not have statistically significant improvement in BP-related functional limitations over time, unlike whites, Asians, and non-Hispanics; however, the magnitude of differences in improvement between groups was small. Blacks had less spine-related health care utilization over 24 months than whites (spine-related RVU ratio of means 0.66, 95% confidence interval [CI] 0.51-0.86). Hispanics had less spine-related health care utilization than non-Hispanics (spine-related RVU ratio of means 0.60; 95% CI 0.40-0.90).

Conclusion: Blacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. Residual confounding may explain some of the association between race/ethnicity and health outcomes. Further studies are needed to understand the factors underlying these differences and which differences reflect disparities.

Level of evidence: 3.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Back Pain / ethnology*
  • Back Pain / therapy
  • Cohort Studies
  • Continental Population Groups / ethnology*
  • Episode of Care*
  • Ethnic Groups*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Patient Acceptance of Health Care*
  • Patient Reported Outcome Measures*