Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.
Spine J. 2021 Jan;21(1):64-70. doi: 10.1016/j.spinee.2020.07.018. Epub 2020 Aug 5.
Since implementation of the Patient Protection and Affordable Care Act (ACA) in 2010, more Americans have health insurance, and many racial/ethnic disparities in healthcare have improved. We previously reported that Black and Hispanic patients undergo surgery for spinal stenosis at lower rates than do white patients.
To assess changes in racial/ethnic disparities in rates of lumbar spinal surgery after passage of the ACA.
Retrospective analysis.
Approximately 3.2 million adults who underwent lumbar spinal surgery in the US from 2006 through 2014.
Racial disparities in discharge rates before versus after ACA passage.
Using the Nationwide Inpatient Sample, the U.S. Census Bureau Current Population Survey Supplement, and International Classification of Diseases, Ninth Revision, Clinical Modification, criteria for definite lumbar spinal surgery, we calculated rates of lumbar spinal surgery as the number of hospital discharges divided by population estimates and stratified patients by race/ethnicity after controlling for sociodemographic characteristics. Calendar years were stratified as before ACA passage (2006-2010) or after ACA passage (2011-2014). Poisson regression was used to model hospital discharge rates as a function of race/ethnicity before and after ACA passage after adjustment for potential confounders.
All rates are expressed per 1,000 persons. The overall median discharge rate decreased from 1.9 before ACA passage to 1.6 after ACA passage (p < .001). After adjustment for sociodemographic factors, the Black:White disparity in discharge rates decreased from 0.40:1 before ACA to 0.44:1 after ACA (p < .001). A similar decrease in the Hispanic:White disparity occurred, from 0.35:1 before ACA to 0.38:1 after ACA (p < .001).
Small but significant decreases occurred in racial/ethnic disparities in hospital discharge rates for lumbar spinal surgery after ACA passage.
自 2010 年《患者保护与平价医疗法案》（ACA）实施以来，更多的美国人拥有了医疗保险，许多医疗保健方面的种族/民族差异有所改善。我们之前报告说，黑人和西班牙裔患者接受脊柱狭窄手术的比率低于白人患者。
评估《平价医疗法案》通过后，脊柱手术种族/民族差异率的变化。
回顾性分析。
2006 年至 2014 年期间，在美国接受腰椎脊柱手术的约 320 万成年人。
ACA 通过前后出院率的种族差异。
使用全国住院患者样本、美国人口普查局当前人口调查补编和国际疾病分类，第九修订版，临床修正，我们根据种族/民族对腰椎脊柱手术的明确标准计算了腰椎脊柱手术的比率，将医院出院人数除以人口估计数，并在控制社会人口统计学特征后对患者进行分层。将历年分为 ACA 通过前（2006-2010 年）或 ACA 后（2011-2014 年）。泊松回归用于在调整潜在混杂因素后，根据 ACA 通过前后种族/民族建模医院出院率。
所有比率均以每 1000 人表示。总体中位数出院率从 ACA 前的 1.9 下降到 ACA 后的 1.6（p <.001）。在调整社会人口统计学因素后，黑人：白人出院率差异从 ACA 前的 0.40:1 下降到 ACA 后的 0.44:1（p <.001）。同样，西班牙裔：白人的差异也从 ACA 前的 0.35:1 下降到 ACA 后的 0.38:1（p <.001）。
ACA 通过后，腰椎脊柱手术的种族/民族差异出院率出现了较小但有意义的下降。
