Low back pain-driven inpatient stays in the United States: a nationwide repeated cross-sectional analysis
Lingxiao Chen, Qingyu Sun, Roger Chou, David B. Anderson, Baoyi Shi, Yujie Chen, Xinyu Liu, Shiqing Feng, Hengxing Zhou, Manuela L. Ferreira- General Medicine
- Surgery
Background
Low back pain (LBP)-driven inpatient stays are resource-intensive and costly, yet data on contemporary national trends are limited.
Materials and methods:
This study used repeated cross-sectional analyses through a nationally representative sample (US National Inpatient Sample, 2016 to 2019). Outcomes included the rate of LBP-driven inpatient stays; the resource utilization (the proportion of receiving surgical treatments and hospital costs) and prognosis (hospital length of stay and the proportion of non-routine discharge) among LBP-driven inpatient stays. LBP was classified as overall, non-specific, and specific (i.e., cancer, cauda equina syndrome, vertebral infection, vertebral compression fracture, axial spondyloarthritis, radicular pain, and spinal canal stenosis). Analyses were further stratified by age, sex, and race/ethnicity.
Results:
292,987 LBP-driven inpatient stays (weighted number: 1,464,690) were included, with 269,080 (91.8%) of these for specific LBP and 23,907 (8.2%) for non-specific LBP. The rate of LBP-driven inpatient stays varied a lot across demographic groups and LBP subtypes (e.g., for overall LBP, highest for non-Hispanic White 180.4 vs. lowest for non-Hispanic Asian/Pacific Islander 42.0 per 100,000 population). Between 2016 and 2019, the rate of non-specific LBP-driven inpatient stays significantly decreased (relative change: 46.9%), however, substantial variations were found within subcategories of specific LBP - significant increases were found for vertebral infection (relative change: 17.2%), vertebral compression fracture (relative change: 13.4%), and spinal canal stenosis (relative change: 19.9%), while a significant decrease was found for radicular pain (relative change: 12.6%). The proportion of receiving surgical treatments also varied a lot (e.g., for overall LBP, highest for non-Hispanic White 74.4% vs. lowest for non-Hispanic Asian/Pacific Islander 62.8%), and significantly decreased between 2016 and 2019 (e.g., for non-specific LBP, relative change: 28.6%). Variations were also observed for other outcomes.
Conclusions:
In the US, the burden of LBP-driven inpatient stays (i.e., rates of LBP-driven inpatient stays, resource utilization and prognosis among LBP-driven inpatient stays) is enormous. More research is needed to understand why the burden varies considerably according to the LBP subtype (i.e., non-specific and specific LBP as well as subcategories of specific LBP) and the subpopulation concerned (i.e., stratified by age, sex, and race/ethnicity).