Nassar Joseph E, Farias Michael J, Singh Manjot, Xu Andrew, Ammar Lama A, Daher Mohammad, Knebel Ashley, Diebo Bassel G, Daniels Alan H
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI, 02914, USA.
Spine Deform. 2025 May 28. doi: 10.1007/s43390-025-01118-8.
Racial and ethnic disparities in healthcare access remain underexplored among adult spinal deformity (ASD) patients in terms of cost related and non-cost related barriers to care.
This cross-sectional study analyzed healthcare access and utilization survey data from the National Institutes of Health's All of Us Research Program (May 6th, 2018-January 30th, 2025). The participants included adults aged ≥ 40 years with spinal deformity enrolled online or through partner organizations across the US. The cost and non-cost barriers to health among ASD patients by race and ethnicity were reported. Multivariate logistic regressions were used to analyze the relationship between race and ethnicity and experiencing barriers to care.
This study included 7272 ASD patients of which 5635 were White (74.5%) (median age, 69 years [IQR, 60.0-75.0]), 535 Hispanic (7.4%) (60.0 years [51.0-68.0]), 538 (7.4%) Black (61.5 years [52.0-69.0]) and 564 (7.8%) of other race and ethnicity (65.0 years [55.0-74.0]) of whom 528 (7.3%) proceeded to undergo correction surgery. Compared to White patients, Black patients had higher odds of reporting delayed general care (adjusted odds ratio [aOR, 2.5; 95% CI 1.7-3.8), follow-up care (aOR, 1.6; 95% CI 1.1-2.3), and prescription filling (aOR, 1.5; 95% CI 1.1-1.9) due to cost. Non-cost barriers for Black patients included lack of transportation aOR, 3.2; 95% CI 2.3-4.3) while Hispanic patients had higher odds of reporting delayed care due to childcare (aOR, 2.9; 95% CI 1.5-5.5) and care to an adult (aOR, 1.8; 95% CI 1.0-3.3) responsibilities. Black and Hispanic patients had higher odds of placing importance on having a provider with a similar background (aOR, 2.4; 95% CI 1.9-3.0; aOR, 3.1, 95% CI 2.4-3.9) and of never having had such a provider (aOR, 4.6; 95% CI 3.2-6.6; aOR, 3.1, 95% CI 2.4-3.9), respectively. They also had higher odds of reporting delayed care due to provider background differences (aOR, 1.9, 95% CI 1.4-2.4; aOR, 1.6, 95% CI 1.2-2.2), respectively. Additionally, Hispanic patients had higher odds of reporting not being treated with respect by their provider (aOR, 1.6; 95% CI 1.0-2.5).
Racial and ethnic disparities significantly impact ASD patients with Hispanic and Black patients facing higher rates of cost and non-cost barriers to care. The healthcare practitioners especially those specializing in ASD play a crucial role in recognizing and addressing these disparities to improve healthcare access and outcomes across racial and ethnic groups.
Prognostic Level III.
在成年脊柱畸形（ASD）患者中，医疗保健可及性方面的种族和族裔差异在与费用相关和与费用无关的护理障碍方面仍未得到充分研究。
这项横断面研究分析了美国国立卫生研究院“我们所有人”研究计划（2018年5月6日至2025年1月30日）的医疗保健可及性和利用调查数据。参与者包括年龄≥40岁、患有脊柱畸形的成年人，他们通过在线或美国各地的合作组织招募。报告了ASD患者按种族和族裔划分的健康费用和非费用障碍。使用多因素逻辑回归分析种族和族裔与经历护理障碍之间的关系。
本研究纳入了7272例ASD患者，其中5635例为白人（74.5%）（中位年龄69岁[四分位间距，60.0 - 75.0]），535例为西班牙裔（7.4%）（60.0岁[51.0 - 68.0]），538例为黑人（7.4%）（61.5岁[52.0 - 69.0]），564例为其他种族和族裔（7.8%）（65.0岁[55.0 - 74.0]），其中528例（7.3%）接受了矫正手术。与白人患者相比，黑人患者因费用问题报告延迟一般护理（调整优势比[aOR，2.5；95%置信区间1.7 - 3.8]）、后续护理（aOR，1.6；95%置信区间1.1 - 2.3）和处方配药（aOR，1.5；95%置信区间1.1 - 1.9）的几率更高。黑人患者的非费用障碍包括缺乏交通工具（aOR，3.2；95%置信区间2.3 - 4.3），而西班牙裔患者因育儿责任（aOR，2.9；95%置信区间1.5 - 5.5）和照顾成年人责任（aOR，1.8；95%置信区间1.0 - 3.3）报告延迟护理的几率更高。黑人和西班牙裔患者分别更重视拥有背景相似的医疗服务提供者（aOR，2.4；95%置信区间1.9 - 3.0；aOR，3.1，95%置信区间2.4 - 3.9），且从未有过此类提供者的几率更高（aOR，4.6；95%置信区间3.2 - 6.6；aOR，3.1，95%置信区间2.4 - 3.9）。他们因医疗服务提供者背景差异报告延迟护理的几率也分别更高（aOR分别为1.9，95%置信区间1.4 - 2.4；aOR，1.6，95%置信区间1.2 - 2.2）。此外，西班牙裔患者报告未得到医疗服务提供者尊重的几率更高（aOR，1.6；95%置信区间1.0 - 2.5）。
种族和族裔差异显著影响ASD患者，西班牙裔和黑人患者面临更高的费用和非费用护理障碍发生率。医疗从业者，尤其是那些专门从事ASD治疗的从业者，在认识和解决这些差异以改善不同种族和族裔群体获得医疗保健的机会和结果方面发挥着关键作用。
预后水平III。
