Allen-Watts Kristen, Sims Andrew M, Buchanan Taylor L, DeJesus Danica J B, Quinn Tammie L, Buford Thomas W, Goodin Burel R, Rumble Deanna D
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States.
School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Front Pain Res (Lausanne). 2022 Jan 26;2:806310. doi: 10.3389/fpain.2021.806310. eCollection 2021.
Chronic low back pain (cLBP) is the most common reason for individual suffering and health care utilization in adults. Ample evidence suggests sociodemographic variables and socioeconomic status (SES) influence pain. However, a framework informing associations on race, SES, and the utilization of pharmacologic therapies and provider type are limited-particularly in cLBP. Thus, this study examined the extent to which sociodemographic (i.e., age, race, and gender) and socioeconomic factors (i.e., national area deprivation index, NADI) influence pain treatment (i.e., NSAIDs, opioids, antidepressants, and non-NSAIDs) and provider utilization for cLBP (i.e., no provider care, primary care, or tertiary care). Eligible participants with cLBP completed a series of questionnaires. Of the 174 participants, 58% were women, 59% were non-Hispanic Black (NHB), and the mean age was 46.10 (SD 13.58). Based on NADI distributions by race, NHB participants lived in more socioeconomically disadvantaged neighborhoods ( < 0.001) than non-Hispanic White (NHW) adults. Results suggested that the use of one or more pharmacologic therapies was associated with race ( = 0.021). Specifically, NHW adults were two times more likely to take one or more pharmacologic therapies than NHBs ( = 0.009). NHWs were also more likely to use NSAIDs ( = 0.041) and antidepressants ( < 0.001) than NHBs. Furthermore, provider utilization was significantly associated with gender ( = 0.037) and age ( = 0.018); which suggests older women were more likely to use primary or tertiary care. Findings from this study expand on the existing literature as it relates to associations between disparities in access to healthcare providers and access to medications. Future research should seek to understand differences in age and utilization of primary or tertiary care providers and continue to examine the influence of sociodemographic and SES factors to cLBP and compare with other types of chronic pain.
慢性下腰痛(cLBP)是成年人个人痛苦和医疗保健利用的最常见原因。大量证据表明,社会人口统计学变量和社会经济地位(SES)会影响疼痛。然而,一个能够说明种族、SES与药物治疗利用以及医疗服务提供者类型之间关联的框架是有限的——尤其是在cLBP方面。因此,本研究调查了社会人口统计学因素(即年龄、种族和性别)和社会经济因素(即国家地区贫困指数,NADI)在多大程度上影响cLBP的疼痛治疗(即非甾体抗炎药、阿片类药物、抗抑郁药和非非甾体抗炎药)以及医疗服务提供者的利用情况(即无医疗服务提供者护理、初级护理或三级护理)。符合条件的cLBP参与者完成了一系列问卷调查。在174名参与者中,58%为女性,59%为非西班牙裔黑人(NHB),平均年龄为46.10岁(标准差13.58)。根据按种族划分的NADI分布,NHB参与者居住的社区在社会经济方面比非西班牙裔白人(NHW)成年人更处于不利地位(<0.001)。结果表明,使用一种或多种药物治疗与种族有关(=0.021)。具体而言,NHW成年人服用一种或多种药物治疗的可能性是非西班牙裔黑人的两倍(=0.009)。与NHB相比,NHW使用非甾体抗炎药(=0.041)和抗抑郁药(<0.001)的可能性也更高。此外,医疗服务提供者的利用与性别(=0.037)和年龄(=0.018)显著相关;这表明老年女性更有可能使用初级或三级护理。本研究的结果扩展了现有文献中关于获得医疗服务提供者和获得药物之间差异关联的内容。未来的研究应试图了解年龄差异以及初级或三级护理提供者的利用情况,并继续研究社会人口统计学和SES因素对cLBP的影响,并与其他类型的慢性疼痛进行比较。