DOI: 10.1097/bsd.0000000000002202 ISSN: 2380-0186

Association Between Self-Reported Healthcare Barriers and Lumbar Spine Surgery Utilization

Ethan D.L. Brown, Barnabas Obeng-Gyasi, Brett Silber, Daniel Schneider, Weston Troja, Trenton A. Line, Aladine A. Elsamadicy, James Miller, Gordon Mao
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Study Design:

This cross-sectional study was conducted on version 7 of the All of Us Researcher Workbench database and involved a cohort of patients with intervertebral disc disorders, spondylolysis, lumbago, and unspecified lumbar disc disorders who completed the Health Care Access and Utilization Survey. Participants with ethno-racial identities of non-Hispanic White, non-Hispanic Black, and Hispanic were included for regression analyses.

Objective:

Determine whether self-reported barriers to care predict lumbar spinal surgery utilization among patients of various backgrounds with degenerative lumbar spine conditions (DLSC).

Summary of Background Data:

Access to surgery is often influenced by demographic and socioeconomic factors, with ethnic minorities facing greater healthcare barriers. Little is known regarding the effect of self-reported obstacles on surgical utilization.

Methods:

This cross-sectional survey utilized the All of Us Research Program database to analyze adults diagnosed with DLSC who completed the Health Care Access and Utilization survey. Subgroup analyses were conducted for White, Black, and Hispanic participants.

Results:

Of 23,258 patients, 1245 (5.4%) underwent lumbar spine surgery. Surgical utilizers tended to be older (mean age: 68 vs. 64 y, P <0.001) and more likely male (44% vs. 33%, P <0.001). Unadjusted regression models indicated that barriers were associated with reduced surgical utilization overall (UOR: 0.74, 95% CI: 0.65–0.84, P <0.001) and among White participants (UOR: 0.78, 95% CI: 0.68–0.89, P <0.001). Specific barriers, including nervousness (UOR: 0.70, 95% CI: 0.56–0.86), cost concerns, and differing provider background (UOR: 0.71, 95% CI: 0.58–0.88, P =0.001), were significantly associated with reduced surgical utilization. Subgroup analyses highlighted important racial/ethnic differences: excessive deductibles (AOR: 0.22, 95% CI: 0.05–0.91, P =0.037) and out-of-pocket costs (AOR: 0.28, 95% CI: 0.10–0.77, P =0.014) were linked to lower surgical utilization among Hispanic participants.

Conclusions:

Self-reported barriers to care, particularly cost-related concerns and nervousness, may be associated with variable surgical utilization in DLSC patients across racial/ethnic groups.

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