Racial, ethnic and socioeconomic disparities in healthcare for adult spinal deformity patients

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Level of evidence: Prognostic Level III.

Keywords: Adult spinal deformity; Barriers to care; Ethnicity; Race.