Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease

Price, Meghan; Ramos, Rafael De la Garza; Dalton, Tara; McCray, Edwin; Pennington, Zach; Erickson, Melissa; Walsh, Kyle M.; Yassari, Reza; Sciubba, Daniel M.; Goodwin, Andrea N.; Goodwin, C. Rory

doi:10.1016/j.canep.2021.102073

Cited by 8 publications

(11 citation statements)

References 41 publications

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“…28 An additional investigation using the same database determined that patients with late-stage cancer and Medicaid insurance exhibited an elevated incidence of metastatic epidural spinal cord compression, reduced likelihood of elective surgical intervention, prolonged hospitalization, and higher incidence of non-home discharge. 29 While intrinsic social determinants may largely explain survival disparities across SES quintiles, the findings of our study also demonstrate notable demographic heterogeneity across SES groups. 73.6% of patients with lowest SES status lived in metropolitan areas, compared with 99.6% of patients with highest SES status (P , 0.001).…”

Section: Discussionmentioning

confidence: 53%

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Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

Mani,

Kleinbart,

Schlumprecht

et al. 2024

J Am Acad Orthop Surg

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Background: The effect of socioeconomic status (SES) on the outcomes of patients with metastatic cancer to bone has not been adequately studied. We analyzed the association between the Yost Index, a composite geocoded SES score, and overall survival among patients who underwent nonprimary surgical resection for bone metastases. Methods: This population-based study used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results database (2010 to 2018). We categorized bone and joint sites using International Classification of Disease-O-3 recodes. The Yost Index was geocoded using a factor analysis and categorized into quintiles using census tract–level American Community Service 5-year estimates and seven measures: median household income, median house value, median rent, percent below 150% of the poverty line, education index, percent working class, and percent unemployed. Multivariate Cox regression models were used to calculate adjusted hazard ratios of overall survival and 95% confidence intervals. Results: A total of 138,158 patients were included. Patients with the lowest SES had 34% higher risk of mortality compared with those with the highest SES (adjusted hazard ratio of 1.34, 95% confidence interval: 1.32 to 1.37, P < 0.001). Among patients who underwent nonprimary surgery of the distant bone tumor (n = 11,984), the age-adjusted mortality rate was 31.3% higher in the lowest SES patients compared with the highest SES patients (9.9 versus 6.8 per 100,000, P < 0.001). Patients in the lowest SES group showed more racial heterogeneity (63.0% White, 33.5% Black, 3.1% AAPI) compared with the highest SES group (83.9% White, 4.0% Black, 11.8% AAPI, P < 0.001). Higher SES patients are more likely to be married (77.5% versus 59.0%, P < 0.0001) and to live in metropolitan areas (99.6% versus 73.6%, P < 0.0001) compared with lower SES patients. Discussion: Our results may have implications for developing interventions to improve access and quality of care for patients from lower SES backgrounds, ultimately reducing disparities in orthopaedic surgery.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

Mani,

Kleinbart,

Schlumprecht

et al. 2024

J Am Acad Orthop Surg

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“…An analysis of patient and socioeconomic factors included in the United States National Inpatient Sample found that non-White patients with a lower income and public insurance were more likely to undergo nonelective surgery for metastatic spine disease [5]. An additional query from this same database found that among patients with late-stage cancer, those with Medicaid coverage were more likely to have metastatic epidural spinal cord compression, were less likely to undergo surgery, and had longer hospital stays and higher rates of nonhome discharge [13]. Socioeconomic factors were also associated with radiotherapy outcomes.…”

Section: Where Are We Now?mentioning

confidence: 99%

CORR Insights®: Are There Racial or Socioeconomic Disparities in Ambulatory Outcome or Survival After Oncologic Spine Surgery for Metastatic Cancer? Results From a Medically Underserved Center

Fourman

2022

Clin Orthop Relat Res

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“…Key words: spine surgery, radiculopathy, myelopathy, insurance, health economics, health care access Spine 2023;48:1003-1008 I n the United States, disparities exist in access to surgical care and perioperative outcomes based on patient insurance status. 1,2 A body of literature including a recent systematic review has demonstrated wide disparities with regard to access and outcomes in patients with Medicaid insurance undergoing spine surgery. 3 Medicaid and other public plans pay providers substantially lower rates for health services rendered compared with commercial plans.…”

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confidence: 99%

“…In the United States, disparities exist in access to surgical care and perioperative outcomes based on patient insurance status 1,2 . A body of literature including a recent systematic review has demonstrated wide disparities with regard to access and outcomes in patients with Medicaid insurance undergoing spine surgery 3 .…”

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confidence: 99%

Variation in Commercial Insurance Type Impacts Access to Cervical Spine Surgery

Durand

Ortiz-Babilonia

Raad

et al. 2022

Spine

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Introduction. Prior literature has demonstrated that disparities exist in health care access and outcomes by insurance status, and patients with commercial plans fare better than those with Medicaid. However, variation may exist within commercial plans, which may impact care access. The purpose of our study was to determine the association between commercial health insurance plan type and access/time to surgery among patients with degenerative cervical conditions. Methods. The MarketScan database (IBM Watson Health, Ann Arbor, MI) was utilized to identify the first instance of International Classification of Diseases-10-CM diagnosis codes for cervical myelopathy and radiculopathy. Patients 65 years old or below enrolled from 2015 to 2020 with a minimum of two years of continuous enrollment were included. Surgery for myelopathy included anterior cervical discectomy and fusion (ACDF), posterior cervical laminectomy and fusion, and laminoplasty, whereas surgery for radiculopathy included ACDF, cervical disk arthroplasty, and foraminotomy. The time between first diagnosis and surgery was determined. Insurance plan type was categorized as noncapitated (NC), non-high-deductible health plan, Health Management Organization-type partially or fully capitated plans, or high-deductible health plans (HDHP). Proportional hazards regression was utilized to compare time-to-incidence of surgery by plan type, adjusting for age, and sex. Results. In total, 55,954 patients with cervical myelopathy and 705,117 patients with cervical radiculopathy were included. Mean follow-up was 537 and 657 days for myelopathy and radiculopathy, respectively. At two years postdiagnosis, 22.6% of myelopathy and 5.6% of radiculopathy patients were managed surgically. ACDF was the most common surgery for both myelopathy (85.7%

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Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease

Cited by 8 publications

References 41 publications

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

CORR Insights®: Are There Racial or Socioeconomic Disparities in Ambulatory Outcome or Survival After Oncologic Spine Surgery for Metastatic Cancer? Results From a Medically Underserved Center

Variation in Commercial Insurance Type Impacts Access to Cervical Spine Surgery

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