种族和民族与老年新发腰痛患者报告结局和医疗保健利用的关联。
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.
机构信息
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Comparative Effectiveness, Cost and Outcomes Research Center (CECORC), University of Washington, Seattle, WA.
出版信息
Spine (Phila Pa 1976). 2018 Jul 15;43(14):1007-1017. doi: 10.1097/BRS.0000000000002499.
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
研究设计
利用纵向数据（BOLD）队列研究对背痛结果进行二次分析。
目的
描述自报种族/民族与新出现背痛患者的背痛（BP）患者报告结局（PROs）和医疗保健利用之间的关系在老年人群中。
背景资料概要
以前没有纵向研究在美国，没有描述多个种族/民族群体与 BP 相关的 PRO 和医疗保健利用之间的关系。
方法
本研究纳入了来自三个美国医疗保健系统的 5117 名年龄≥65 岁的参与者。主要的 BP 相关 PRO 是 24 个月内的 BP 强度和与背部相关的功能限制。24 个月内的医疗保健利用措施包括与 BP 相关的常见诊断测试和治疗（脊柱成像、脊柱相关相对价值单位 [RVU] 和总 RVU）。分析调整了多个潜在混杂因素，包括社会人口统计学、临床特征和研究地点。
结果
基线时，黑人的 BP 评分明显高于白人（5.8 对 5.0；P<0.001）。所有种族/民族群体的参与者在 24 个月内 BP 均有统计学显著但适度的改善。与白人、亚洲人和非西班牙裔人不同，黑人（ Hispanics ）和西班牙裔人（ Hispanics ）的 BP 相关功能限制随时间没有统计学上的显著改善；然而，各组之间改善程度的差异很小。与白人相比，黑人在 24 个月内脊柱相关医疗保健利用率较低（脊柱相关 RVU 均值比 0.66，95%置信区间 [CI] 0.51-0.86）。与非西班牙裔人相比，西班牙裔人的脊柱相关医疗保健利用率较低（脊柱相关 RVU 均值比 0.60；95%CI 0.40-0.90）。
结论
与白人（ whites ）和非西班牙裔人（ non-Hispanics ）相比，黑人（ blacks ）和西班牙裔人（ Hispanics ）随时间推移，BP 相关功能限制的改善略少，脊柱相关医疗保健利用率也较低。残留混杂因素可能解释了种族/民族与健康结果之间的部分关联。需要进一步的研究来了解这些差异背后的因素，以及哪些差异反映了差异。
证据水平
3。
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