黑人和白人肌肉骨骼疼痛患者在物理治疗的利用和利用时间上存在差异。

Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain.

机构信息

Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA.

Department of Health and Clinical Outcomes Research, Salus Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.

出版信息

Phys Ther. 2022 Oct 6;102(10). doi: 10.1093/ptj/pzac095.

DOI:10.1093/ptj/pzac095

PMID:35871435

Abstract

OBJECTIVE

Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis.

METHODS

Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses.

RESULTS

Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66).

CONCLUSIONS

In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain.

IMPACT

These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.

摘要

目的

黑种人患者接受肌肉骨骼疼痛病症物理治疗的可能性低于白种人患者。然而，现有证据仅限于自我报告的病症和卫生服务利用情况。本研究的目的是利用大型电子健康记录数据库确定在新的肌肉骨骼诊断后 90 天内，物理治疗的利用是否存在种族差异。

方法

从美国各地的 500 万成年人组成的 Optum 去识别电子健康记录数据库中抽取符合条件的患者（n=52384）。在该数据库中，患者被指定为“黑种人”和“白种人”。如果患者在 2012 年 1 月 1 日至 2017 年 12 月 31 日期间有新的肌肉骨骼颈部、肩部、背部或膝关节疼痛诊断，则符合条件。在调整协变量之前和之后，计算逻辑回归和 Cox 比例风险模型，以估计种族与肌肉骨骼疼痛诊断后 90 天内接受物理治疗服务之间的关联。

结果

患者的平均年龄为 47.5（SD=14.9）岁，12.8%为黑种人，87.2%为白种人，52.7%为女性。10%的黑种人患者和 15.5%的白种人患者在肌肉骨骼疼痛诊断后 90 天内接受了物理治疗服务。在调整协变量后，与黑种人患者相比，白种人患者接受物理治疗的可能性高 57%（优势比=1.57；95%置信区间=1.44-1.71），并且接受物理治疗的时间明显短于黑种人患者（风险比=1.53；95%置信区间=1.42-1.66）。