Gu C N, Brinjikji W, El-Sayed A M, Cloft H, McDonald J S, Kallmes D F
From the Departments of Radiology (C.N.G., W.B., H.C., J.S.M., D.F.K.)
From the Departments of Radiology (C.N.G., W.B., H.C., J.S.M., D.F.K.).
AJNR Am J Neuroradiol. 2014 Dec;35(12):2397-402. doi: 10.3174/ajnr.A4044. Epub 2014 Jul 10.
Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.
Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using χ(2) tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use.
A total of 228,329 patients were included in this analysis, of whom 129,206 (56.6%) received spine augmentation. Among patients with spine augmentation, 97,022 (75%) received kyphoplasty and 32,184 (25%) received vertebroplasty; 57.5% (92,779/161,281) of white patients received spine augmentation compared with 38.7% (1405/3631) of black patients (P < .001). Hispanic patients had significantly lower spine augmentation rates compared with white patients (52.3%, 3777/7222, P < .001) as did Asian/Pacific Islander patients (53.1%, 1784/3361, P < .001). The spine augmentation usage rate was 57.2% (114,768/200,662) among patients with Medicare, significantly higher than that of those with Medicaid (43.9%, 1907/4341, P < .001) and those who self-pay (40.2%, 488/1214, P < .001).
Our findings demonstrate substantial racial and health insurance-based disparities in the inpatient use of spinal augmentation for the treatment of osteoporotic vertebral fracture.
椎体成形术和后凸成形术常用于治疗有症状的椎体骨折。虽然先前的研究已经表明在背痛治疗和骨质疏松症患者护理方面存在差异，但脊柱强化治疗方面的差异尚未得到研究。我们调查了美国在使用脊柱强化治疗骨质疏松性椎体骨折方面的种族和健康保险状况差异。
利用2005年至2010年的全国住院患者样本，我们选取了所有主要诊断为椎体骨折（国际疾病分类-9编码733.13）的出院病例。接受脊柱强化治疗的患者通过使用国际疾病分类-9手术编码81.65（椎体成形术）和81.66（后凸成形术）来确定。诊断为癌症的患者被排除。我们比较了按种族/民族（白人、黑人、西班牙裔和亚裔/太平洋岛民）和保险状况（医疗保险、医疗补助、自费和私人保险）划分的脊柱强化治疗使用率。组间比较采用χ²检验。进行多因素逻辑回归分析以确定与脊柱强化治疗使用相关的变量。
本分析共纳入228,329例患者，其中129,206例（56.6%）接受了脊柱强化治疗。在接受脊柱强化治疗的患者中，97,022例（75%）接受了后凸成形术，32,184例（25%）接受了椎体成形术；57.5%（92,779/161,281）的白人患者接受了脊柱强化治疗，而黑人患者的这一比例为38.7%（1405/3631）（P <.001）。西班牙裔患者的脊柱强化治疗率显著低于白人患者（52.3%，3777/7222，P <.001），亚裔/太平洋岛民患者也是如此（53.1%，1784/3361，P <.001）。医疗保险患者的脊柱强化治疗使用率为57.2%（114,768/200,662），显著高于医疗补助患者（43.9%，1907/4341，P <.001）和自费患者（40.2%，488/1214，P <.001）。
我们的研究结果表明，在住院治疗骨质疏松性椎体骨折时，脊柱强化治疗在种族和基于健康保险方面存在显著差异。
