Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Spine (Phila Pa 1976). 2021 Apr 1;46(7):464-471. doi: 10.1097/BRS.0000000000003811.
Retrospective, observational study.
To determine the association of patient socioeconomic disadvantage, insurance type, and other characteristics on presenting symptom severity in patients with isolated lumbar disc herniation.
Little is known of the impact of socioeconomic disadvantage and other patient characteristics on the level of self-reported symptom severity when patients first seek care for lumbar disc herniation.
Between April 2015 and December 2018, 734 patients newly presenting for isolated lumbar disc herniation who completed the Patient-Reported Outcomes Measurement Information System Physical Function (PF), Pain Interference (PI), and Depression Computer Adaptive Tests (CATs) were identified. Socioeconomic disadvantage was determined using the Area Deprivation Index, a validated measure of socioeconomic disadvantage at the census block group level (0-100, 100 = highest socioeconomic disadvantage). Bivariate analyses were used. Multivariable linear regression was used to determine if there was an association between socioeconomic disadvantage, insurance type, and other patient factors and presenting patient-reported health status.
Significant differences in age, insurance type, self-reported race, marital status, and county of residence were appreciated when comparing patient characteristics by socioeconomic disadvantage levels (all comparisons, P < 0.01). In addition, significant differences in age, insurance type, marital status, and county of residence were appreciated when comparing patient characteristics by self-reported race (all comparisons, P < 0.01). Being in the most socioeconomically disadvantaged cohort was associated with worse presenting Patient-Reported Outcomes Measurement Information System scores (Physical Function: β = -3.27 (95% confidence interval [CI]: -4.89 to -1.45), P < 0.001; Pain Interference: β = 3.20 (95% CI: 1.58-4.83), P < 0.001; Depression: β = 3.31 (95% CI: 1.08-5.55), P = 0.004.
The most socioeconomically disadvantaged patients with symptomatic lumbar disc herniations present with worse functional limitations, pain levels, and depressive symptoms as compared to patients from the least socioeconomically disadvantaged cohort when accounting for other key patient factors.Level of Evidence: 3.
回顾性观察研究。
确定患者社会经济劣势、保险类型和其他特征与孤立性腰椎间盘突出症患者就诊时症状严重程度的关系。
当患者首次因腰椎间盘突出症寻求治疗时，对于社会经济劣势和其他患者特征对自我报告症状严重程度的影响知之甚少。
在 2015 年 4 月至 2018 年 12 月期间，确定了 734 名新出现孤立性腰椎间盘突出症的患者，他们完成了患者报告的结局测量信息系统身体功能（PF）、疼痛干扰（PI）和抑郁计算机自适应测试（CAT）。使用人口普查块组级别的区域剥夺指数（0-100，100=最高社会经济劣势）来确定社会经济劣势。进行了双变量分析。多变量线性回归用于确定社会经济劣势、保险类型和其他患者因素与就诊时患者报告的健康状况之间是否存在关联。
按社会经济劣势水平比较患者特征时，年龄、保险类型、自我报告种族、婚姻状况和居住县存在显著差异（所有比较，P<0.01）。此外，按自我报告种族比较患者特征时，年龄、保险类型、婚姻状况和居住县也存在显著差异（所有比较，P<0.01）。处于最社会经济劣势群体与较差的就诊患者报告的结局测量信息系统评分相关（身体功能：β=-3.27（95%置信区间[CI]：-4.89 至-1.45），P<0.001；疼痛干扰：β=3.20（95%CI：1.58-4.83），P<0.001；抑郁：β=3.31（95%CI：1.08-5.55），P=0.004）。
与来自社会经济劣势程度最低的队列的患者相比，患有症状性腰椎间盘突出症的最社会经济劣势患者在功能受限、疼痛程度和抑郁症状方面表现出更差的情况，这是在考虑其他关键患者因素的情况下得出的。
3 级。
