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Disparities in Access to Minimally Invasive Treatment for Lumbar Spinal Stenosis

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Access to healthcare remains a critical issue in the United States, with disparities evident across various treatments and procedures. This issue becomes particularly significant in the context of minimally invasive treatments for lumbar spinal stenosis (LSS), such as interspinous spacers without decompression or fusion (ISD). Despite the potential effectiveness of ISD, demographic, socioeconomic, and geographic factors continue to influence accessibility. These disparities necessitate a deeper understanding to formulate strategies for equitable healthcare delivery.

Study Overview

Researchers conducted a retrospective analysis using Medicare data from 2017 to 2022 to examine the prevalence and determinants of ISD implantation among patients diagnosed with LSS. The study aimed to identify how racial, socioeconomic, and geographic factors impact the likelihood of receiving this minimally invasive treatment. The analysis included over 1.3 million individuals, of whom only 0.4% underwent ISD implantation.

Key Findings

The study revealed that older patients, males, and individuals with a lower disease burden were more likely to receive ISD treatment. White patients had a higher likelihood of undergoing ISD implantation compared to other racial groups. The impact of socioeconomic status and race on ISD access varied significantly across different regions in the United States. In regions like the Midwest and Northeast, lower median household income was linked to reduced ISD implantation rates regardless of race. Conversely, in the South, Black patients faced lower ISD implantation rates regardless of their income levels.

The analysis underscores the complexity of healthcare disparities, highlighting the need for targeted interventions to enhance market access for marginalized groups. Addressing these disparities is crucial for ensuring that advancements in minimally invasive treatments benefit all segments of the population.

Concrete Inferences

Key inferences from the study include:

  • Higher socioeconomic status correlates with increased access to minimally invasive treatments.
  • Geographic location significantly influences the likelihood of receiving ISD implantation.
  • Racial disparities persist in healthcare access, with Black patients in the South particularly disadvantaged.

These findings point to the importance of addressing regional and racial disparities to improve market access for innovative treatments.

In conclusion, while ISD offers a promising treatment for LSS, its accessibility remains uneven, influenced by a tapestry of demographic, socioeconomic, and geographic factors. These disparities highlight the need for continued research and policy interventions to ensure equitable access to healthcare advancements.

Original Article:

J Racial Ethn Health Disparities. 2024 Jul 23. doi: 10.1007/s40615-024-02097-8. Online ahead of print.

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ABSTRACT

BACKGROUND: In mild to moderate lumbar spinal stenosis (LSS) where conservative care treatments fail, minimally invasive treatments, such as interspinous spacers without decompression or fusion (ISD), may be appropriate. While previous studies have demonstrated racial and socioeconomic disparities in the surgical treatment of LSS, there are limited data on how those factors impact accessibility to these procedures. This study explored demographic, socioeconomic, and geographic differences in the use of ISD.

METHODS: Using the Medicare 100% files from 2017 through 2022, this retrospective claims analysis identified when and if patients diagnosed with LSS received ISD implantation. Cox proportional hazards regression was used to examine the association between racial and socioeconomic characteristics and the rate of ISD implantation, stratified by geographic region.

RESULTS: A total of 1,316,622 individuals met the inclusion criteria; 4730 (0.4%) underwent ISD implantation, with a mean (standard deviation) time to treatment of 11.9 (13.2) months after diagnosis. The likelihood of ISD implantation was higher for older patients (except for the oldest group), males, those with lower disease burden, and White patients. Cox regression revealed that the associations of racial and socioeconomic factors with ISD implantation varied by U.S. region. In the Midwest and Northeast, lower median household income was associated with a decreased likelihood of ISD implantation regardless of race, while in the South, Black patients were less likely to undergo ISD implantation regardless of income.

CONCLUSIONS: The observed disparities in access to ISD implantation mirror existing trends in surgical interventions for LSS, suggesting further study and interventions are needed to address inequities.

PMID:39042335 | DOI:10.1007/s40615-024-02097-8


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