Icahn School of Medicine at Mount Sinai, New York, New York.
Institute for Healthcare Delivery Science, Departments of Population Health Science and Policy/Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York.
Clin Spine Surg. 2024 Aug 1;37(7):E303-E308. doi: 10.1097/BSD.0000000000001576. Epub 2024 Feb 19.
Retrospective cohort study.
Compare disparities in lumbar surgical care utilization in Commercially insured versus Medicare patients.
While disparities in spinal surgery have been previously described, less evidence exists on effective strategies to mitigate them. Theoretically, universal health care coverage under Medicare should improve health care access.
Utilizing National Inpatient Sample data (2003-2018), we included inpatient lumbar discectomy or laminectomy/fusion cases in black, white, or Hispanic patients aged 18-74 years, with Commercial or Medicare insurance. A multivariable Poisson distribution model determined race/ethnicity subgroup-specific rate ratios (RRs) of patients undergoing lumbar surgery compared to their respective population distribution (using US Census data) based on race/ethnicity, region, gender, primary payor, and age (Commercially insured age subgroups: 18-39, 40-54, and 55-64 y; Medicare age subgroup: 65-74 y).
Of the 2,310,956 lumbar spine procedures included, 88.9%, 6.1%, and 5.0% represented white, black, and Hispanic patients, respectively. Among Commercially insured patients, black and Hispanic (compared to white) patients had lower rates of surgical care utilization; however, these disparities decreased with increasing age: black (RR=0.37, 95% CI: 0.37-0.38) and Hispanic patients (RR=0.53, 95% CI: 0.52-0.54) aged 18-39 years versus black (RR=0.72, 95% CI: 0.71-0.73) and Hispanic patients (RR=0.64, 95% CI: 0.63-0.65) aged 55-64 years. Racial/ethnic disparities persisted in Medicare patients, especially when compared to the neighboring age subgroup that was Commercially insured: black (RR=0.61, 95% CI: 0.60-0.62) and Hispanic patients (RR=0.61, 95% CI: 0.60-0.61) under Medicare.
Disparities in surgical care utilization among black and Hispanic patients persist regardless of health care coverage, and an expansion of Medicare eligibility alone may not comprehensively address health care disparities.
Level III.
回顾性队列研究。
比较商业保险患者和医疗保险患者在腰椎手术治疗利用方面的差异。
尽管先前已经描述了脊柱手术方面的差异，但关于减轻这些差异的有效策略的证据较少。从理论上讲，医疗保险下的全民医疗保健覆盖范围应该改善医疗保健的可及性。
利用国家住院患者样本数据（2003-2018 年），我们纳入了 18-74 岁的黑种人、白种人或西班牙裔患者的住院腰椎间盘切除术或椎板切除术/融合术病例，这些患者具有商业保险或医疗保险。多变量泊松分布模型根据种族/民族、地区、性别、主要支付者和年龄（商业保险年龄亚组：18-39、40-54 和 55-64 岁；医疗保险年龄亚组：65-74 岁），确定了接受腰椎手术的患者与各自人群分布（使用美国人口普查数据）的种族/民族特定率比（RR）。
在 2310956 例腰椎手术中，分别有 88.9%、6.1%和 5.0%代表白种人、黑种人和西班牙裔患者。在商业保险患者中，黑种人和西班牙裔患者（与白种人相比）接受手术治疗的比例较低；然而，这些差异随着年龄的增长而减小：18-39 岁的黑种人（RR=0.37，95%CI：0.37-0.38）和西班牙裔患者（RR=0.53，95%CI：0.52-0.54），以及 55-64 岁的黑种人（RR=0.72，95%CI：0.71-0.73）和西班牙裔患者（RR=0.64，95%CI：0.63-0.65）。在医疗保险患者中，种族/民族差异仍然存在，尤其是与商业保险相邻的年龄亚组相比：黑种人（RR=0.61，95%CI：0.60-0.62）和西班牙裔患者（RR=0.61，95%CI：0.60-0.61）。
无论医疗保健覆盖范围如何，黑人和西班牙裔患者在手术治疗利用方面的差异仍然存在，仅扩大医疗保险资格可能无法全面解决医疗保健差异问题。
三级。
