Safazadeh Ghazaleh, Carlos Ruth C, Shah Lubdha M, Stoddard Gregory J, Steed Rebecca, Hutchins Troy A, Peckham Miriam E
From the Department of Radiology and Imaging Sciences (G.S., L.M.S., T.A.H., M.E.P.), University of Utah Health Sciences Center, Salt Lake City, Utah
Department of Radiology (R.C.C.), University of Michigan, Ann Arbor, Michigan.
AJNR Am J Neuroradiol. 2025 Mar 4;46(3):589-596. doi: 10.3174/ajnr.A8502.
Low back pain (LBP) commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other nonpharmacologic treatments. We posited that individual chart reviews may provide insight into the disparity of care types through documented patient/provider discussions and their effect on treatment plans.
This retrospective analysis involved adults newly diagnosed with LBP in a large Utah health care system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within 1 year of LBP diagnosis between White/non-Hispanic and underrepresented minority cohorts. Secondary outcomes were receipt of additional treatment types (physical therapy and lumbar surgery), time to any treatment, time to image-guided intervention, and discussion/receipt of therapy between cohorts within 1 year of diagnosis.
Among 812 subjects (59% White/non-Hispanic and 41% underrepresented minority), more White/non-Hispanic patients had at least 1 image-guided intervention within 12 months compared with underrepresented minority patients (12.5% versus 7.2%, = .01), despite underrepresented minorities having higher presenting pain scores (64.5% versus 49.3%; pain intensity, >5; = .001). Underrepresented minority patients more often saw generalists (71.7% versus 52.6%, < .001) and advanced practice clinician providers (33.6% versus 25.6%, < .02) compared with the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% versus 19.8%, = .20); however, referral completion was noted less often (60.4% versus 77.7%, = .02) and took longer to complete in underrepresented minority patients (mean, 54 versus 27.5 days; = .003).
Underrepresented minority patients had more severe LBP on presentation but received image-guided interventions less often than White/non-Hispanic patients. Our in-depth chart analysis supports the lack of referral completion and evaluation from a spine specialist provider as the main deterrent to the receipt of image-guided interventions in this cohort. While there may be systematic provider barriers such as an absence of decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.
下腰痛（LBP）通常会导致残疾，在手术前常采用保守的影像引导干预措施进行治疗。研究已记录了这些及其他非药物治疗方面的种族差异。我们推测，通过记录患者/提供者的讨论及其对治疗计划的影响，对个体病历进行审查可能有助于深入了解护理类型的差异。
这项回顾性分析涉及犹他州一个大型医疗系统中 newly diagnosed with LBP 的成年人。主要结局是在白人/非西班牙裔和代表性不足的少数族裔队列中，提供者和患者变量与 LBP 诊断后 1 年内接受影像引导干预的频率之间的关联。次要结局包括接受其他治疗类型（物理治疗和腰椎手术）的情况、开始任何治疗的时间、开始影像引导干预的时间，以及诊断后 1 年内队列之间治疗的讨论/接受情况。
在 812 名受试者中（59%为白人/非西班牙裔，41%为代表性不足的少数族裔），与代表性不足的少数族裔患者相比，更多白人/非西班牙裔患者在 12 个月内至少接受了 1 次影像引导干预（12.5%对 7.2%，P =.01），尽管代表性不足的少数族裔患者的初始疼痛评分更高（64.5%对 49.3%；疼痛强度，>5；P =.001）。与白人/非西班牙裔队列相比，代表性不足的少数族裔患者更常看全科医生（71.7%对 52.6%，P <.001）和高级执业临床医生（33.6%对 25.6%，P <.02）。两个队列被转诊至专科医生的比例相同（17.7%对 19.8%，P =.20）；然而，在代表性不足的少数族裔患者中，转诊完成的情况较少（60.4%对 77.7%，P =.02），且完成转诊所需的时间更长（平均 54 天对 27.5 天；P =.003）。
代表性不足的少数族裔患者就诊时 LBP 更严重，但接受影像引导干预的频率低于白人/非西班牙裔患者。我们的深入病历分析表明，脊柱专科医生缺乏转诊完成和评估是该队列中接受影像引导干预的主要障碍。虽然可能存在系统性的提供者障碍，如缺乏决策讨论，但数据不支持提供者偏见是接受影像引导干预差异的一个促成因素。
