Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta‐analysis

Chen, Qiuzhe; Vella, Simon Paul; Maher, Chris G; Ferreira, Giovanni E; Machado, Gustavo C

doi:10.1002/ejp.2075

Cited by 4 publications

(1 citation statement)

References 72 publications

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“…Research has shown the damaging effect of unconscious bias on healthcare assessment, test ordering, and treatment recommendations (Fitzgerald & Hurst, 2017). For example, racial bias has been shown to influence opioid prescription and surgical intervention in the management of LBP, though the authors were unable to determine the influence on imaging due to low certainty of evidence (Chen et al., 2023). In our review, we found many studies reporting that patient characteristics such as sex, socioeconomic status, and ethnicity influenced imaging CDM, suggesting potential biases.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

Tanner,

Saywell,

Adams

et al. 2024

Musculoskeletal Care

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BackgroundThe use of diagnostic imaging in low back pain (LBP) management is often inappropriate, despite recommendations from clinical practice guidelines. There is a limited understanding of factors that influence the imaging clinical decision‐making (CDM) process.AimExplore the literature on factors influencing imaging CDM for people with LBP and consider how these findings could be used to reduce inappropriate use of imaging in LBP management.DesignScoping review.MethodThis review followed the Preferred Reporting Items for Systematic Review extension for scoping reviews. A digital search was conducted in Medline, the Cumulative Index of Nursing and Allied Health Literature, Scopus, and the Cochrane Central Register of Controlled Trials for eligible studies published between January 2010–2023. Data reporting influences on imaging CDM were extracted. Data were then analysed through an inductive process to group the influencing factors into categories.ResultsAfter screening, 35 studies (5 qualitative and 30 quantitative) were included in the review, which reported factors influencing imaging CDM. Three categories were developed: clinical features (such as red flags, pain, and neurological deficit), non‐modifiable factors (such as age, sex, and ethnicity) and modifiable factors (such as beliefs about consequences and clinical practice). Most studies reported non‐modifiable factors.ConclusionsThe results of this scoping review challenge the perception that imaging CDM is purely based on clinical history and objective findings. There is a complex interplay between clinical features, patient and clinician characteristics, beliefs, and environment. These findings should be considered when designing strategies to address inappropriate imaging behaviour.

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Section: Discussionmentioning

confidence: 99%

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

Tanner,

Saywell,

Adams

et al. 2024

Musculoskeletal Care

View full text Add to dashboard Cite

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Pain: From Innate to Acquired

Marchand

2024

The Pain Phenomenon

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Impact of Racial and Socioeconomic Disparities on Access to Interspinous Spacer for Treatment of Lumbar Spinal Stenosis: A Nationwide Medicare Analysis

Cho,

Tran,

McGovern

et al. 2024

J. Racial and Ethnic Health Disparities

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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.

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Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta‐analysis

Cited by 4 publications

References 72 publications

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

Pain: From Innate to Acquired

Impact of Racial and Socioeconomic Disparities on Access to Interspinous Spacer for Treatment of Lumbar Spinal Stenosis: A Nationwide Medicare Analysis

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