Racial and Health Insurance Disparities of Inpatient Spine Augmentation for Osteoporotic Vertebral Fractures from 2005 to 2010

Gu, Chunhui; Brinjikji, Waleed; El-Sayed, Abdulrahman M.; Cloft, Harry J.; McDonald, Julie; Kallmes, David F.

doi:10.3174/ajnr.a4044

Cited by 15 publications

(14 citation statements)

References 29 publications

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“…Overall usage rates of spinal augmentation procedures have decreased dramatically over the past decade. In a similar analysis of trends in usage of spinal augmentation between 2005 and 2010, Gu et al 12 found that 56.6% of patients admitted for vertebral fracture were treated with either kyphoplasty or vertebroplasty. In our study of patients from 2012 to 2016, only 22.4% of patients admitted for OVCF received spine augmentation.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies focused on OVCF procedural management disparities have highlighted differences in operative rates between racial groups and insurance status, as well as a trend of decreasing vertebroplasty rate. 4,7,12,13 Our study aims to expand on current trends and socioeconomic comparison of spinal augmentation procedures for OVCF, as well as perform unique analyses regarding OVCF operative management as it relates to other hospital, geographic, and socioeconomic factors.…”

Section: Introductionmentioning

confidence: 99%

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Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016

et al. 2022

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Introduction: Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today's aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF. There remain disparities in the use of these procedures as treatment for OVCFs in the United States.Methods: The 2012 to 2016 Nationwide Inpatient Sample was queried for all patients admitted for OVCF. These patients were then grouped based on whether they received conservative vs surgical (kyphoplasty/vertebroplasty) management and compared with respect to various socioeconomic factors including race, insurance coverage, income quartile, hospital control, and geography. Propensity score matching was utilized to control for potential baseline confounders as well as the influence of other endpoints.Results: The search criteria identified 35,199 patients admitted with OVCF, of whom 7900 (22.4%) received spine augmentation. Blacks/African Americans (risk ratios [RR] = 0.79, P < 0.001), Hispanics/Latinos (RR = 0.82, P < 0.001), Asians/Pacific Islanders (RR = 0.81, P = 0.048), and unknown/other races (RR = 0.88, P = 0.037) were less likely to receive surgical management than whites/Caucasians. When compared with Medicare patients, those with Medicaid (RR = 0.76, P < 0.001) were less likely to receive surgery while privately insured patients were more likely (RR = 1.06, P = 0.42). Patients in the West (RR = 0.90, P < 0.001) were less likely to receive surgery for OVCF than those in the Northeast.Conclusions: A wide variety of socioeconomic disparities exists in the use of spinal augmentation for the management of OVCF in the United States, limiting patient access to a potentially beneficial procedure.Clinical Relevance: Retrospective Analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016

et al. 2022

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“…[19,20] Comparably, patients with private insurance have a broader set of options with regards to hospital reputation and geography prior to receiving elective surgery and may even receive spine surgery sooner than patients with Medicare or Medicaid. [21][22][23] As a result, these patients may exhibit better postoperative outcomes and receive surgical treatment more frequently than their counterparts.…”

Section: Discussionmentioning

confidence: 99%

Demographic predictors of treatments and surgical complications of lumbar degenerative diseases

et al. 2022

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This was a national database study.To examine the role of comorbidities and demographics on inpatient complications in patients with lumbar degenerative conditions.Degenerative conditions of the lumbar spine account for the most common indication for spine surgery in the elderly population in the United States. Significant studies investigating demographic as predictors of surgical rates and health outcomes for degenerative lumbar conditions are lacking.Data were obtained from the National Inpatient Sample from 2010 to 2014 and International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with a primary diagnosis of degenerative lumbar condition. Patients were stratified based on demographic variables and comorbidity status. Multivariate regression analyses were used to determine whether any individual demographic variables, such as race, sex, insurance, and hospital status predicted postoperative complications.A total of 256,859 patients were identified for analysis. The rate of overall complications was found to be 16.1% with a mortality rate of 0.10%. Female, Black, Hispanic, and Asian/Pacific Islander patients had lower odds of receiving surgical treatment compared to White patients (P < .001). Medicare and Medicaid patients were less likely to be surgically managed than patients with private insurance (OR = 0.75, 0.37; P < .001, respectively). Urban hospitals were more likely to provide surgery when compared to rural hospitals (P < .001). Patients undergoing fusion had more complications than decompression alone (P < .001). Females, Medicare insurance status, Medicaid insurance status, urban hospital locations, and certain geographical locations were found to predict postoperative complications (P < .001).There were substantial differences in surgical management and postoperative complications among individuals of different sex, races, and insurance status. Further investigation evaluating the effect of demographics in spine surgery is warranted to fully understand their influence on patient complications.

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“…What is also uncertain is how much, if any, of the suspected ‘spill-over’ effect discussed above has influenced these results in black patients. Other studies have reported racial disparities in outcomes and survival of myeloma patients,35 and in patients with osteoporosis who underwent vertebral augmentation;36 however, none have examined disparities related to social determinants of health in myeloma patients with spinal fractures undergoing vertebral augmentation.…”

Section: Discussionmentioning

confidence: 99%

Trends in vertebral augmentation for spinal fractures in myeloma patients: a 2002–2012 population-based study using a large national cancer registry

Chokshi

Howard

Jarvik

et al. 2017

J NeuroIntervent Surg

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Racial and Health Insurance Disparities of Inpatient Spine Augmentation for Osteoporotic Vertebral Fractures from 2005 to 2010

Cited by 15 publications

References 29 publications

Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016

Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016

Demographic predictors of treatments and surgical complications of lumbar degenerative diseases

Trends in vertebral augmentation for spinal fractures in myeloma patients: a 2002–2012 population-based study using a large national cancer registry

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