Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Spine J. 2022 Aug;22(8):1309-1317. doi: 10.1016/j.spinee.2022.03.011. Epub 2022 Mar 26.
Lumbar disc herniations (LDH) are among the most common spinal conditions. Despite increased appreciation for the importance of social determinants of health, the role that these factors play in patients with lumbar disc herniations is poorly defined.
To elucidate the association between insurance status and baseline patient reported outcome measures (PROMs) in the setting of lumbar disc herniations.
STUDY DESIGN/SETTING: Retrospective cohort study PATIENT SAMPLE: Baseline patient-reported outcome measures (PROMS) were reviewed from 924 adult patients presenting for treatment of lumbar disc herniation within our institutional healthcare system (2015-2020).
The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analogue scale (VAS) for back and leg pain were assessed.
PROMIS scores at presentation were defined at the primary outcome and insurance status as the primary predictor. Differences in clinical and sociodemographic characteristics between our cohorts, stratified by insurance status, were evaluated using Wilcoxon rank-sum or chi-squared testing. We used multivariable negative binomial regression modeling to adjust for potential confounders including age, gender, race, language, ethnicity, comorbidity index, and median geospatial household income.
We included 924 patients, with mean age of 58.4 +/- 15.2 years and 52.6% male prevalence. Patients insured through Medicaid were more likely to be Black, Hispanic, and non-English speaking patients compared with the commercially insured. The Charlson Comorbidity index was significantly higher in the Medicare group. Following adjusted analysis, patients with Medicaid insurance had significantly worse PF10a (IRR, 0.90, 95% CI 0.85-0.96), as well as PROMIS Global-Physical score (IRR 0.88, 95% CI 0.82-0.94), and VAS low back pain (IRR 1.20, 95% CI 1.04-1.40) when compared to the commercially insured.
We encountered worse physical function, mental, and pain-related patient-reported outcomes for those with Medicaid insurance in a population of patients presenting for evaluation of lumbar disc herniation. These findings, including worse depression, anxiety, and higher axial back pain scores, merit further investigation into potential health system asymmetries, and should be accounted for by treating providers.
腰椎间盘突出症（LDH）是最常见的脊柱疾病之一。尽管人们越来越认识到健康的社会决定因素的重要性，但这些因素在腰椎间盘突出症患者中的作用仍未得到明确界定。
阐明在腰椎间盘突出症患者中，保险状况与基线患者报告的结局测量（PROMs）之间的关联。
研究设计/背景：回顾性队列研究
对我院医疗机构系统内 924 名成年患者的基线患者报告结局测量（PROMS）进行了回顾性研究（2015-2020 年）。
评估了患者报告的结果测量信息系统（PROMIS）物理功能简短表单 10a（PF10a）、PROMIS 全球心理、PROMIS 全球物理和视觉模拟量表（VAS）用于腰背和腿部疼痛。
将就诊时的 PROMIS 评分定义为主要结局，将保险状况定义为主要预测因素。使用 Wilcoxon 秩和检验或卡方检验评估按保险状况分层的队列之间的临床和社会人口统计学特征差异。我们使用多变量负二项回归模型来调整潜在的混杂因素，包括年龄、性别、种族、语言、族裔、合并症指数和中位数地理空间家庭收入。
我们纳入了 924 名患者，平均年龄为 58.4±15.2 岁，男性患病率为 52.6%。与商业保险相比，通过医疗补助保险的患者更有可能是黑人、西班牙裔和非英语患者。医疗保险组的 Charlson 合并症指数明显较高。在调整后的分析中，医疗保险患者的 PF10a 明显更差（IRR，0.90，95%CI 0.85-0.96），以及 PROMIS 全球物理评分（IRR 0.88，95%CI 0.82-0.94）和 VAS 腰痛（IRR 1.20，95%CI 1.04-1.40），与商业保险相比。
在腰椎间盘突出症患者人群中，我们发现医疗补助保险患者的身体功能、心理和疼痛相关的患者报告结局更差。这些发现，包括更严重的抑郁、焦虑和更高的轴向腰痛评分，值得进一步调查潜在的卫生系统不对称性，并应得到治疗提供者的重视。
