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Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background.

Abstract：

STUDY DESIGN:Retrospective review comparing physician workup of degenerative lumbosacral pathologies between different genders and ethnic groups. OBJECTIVES:To investigate whether patient ethnicity and gender influence the workup and treatment of degenerative spinal pathologies. SUMMARY OF BACKGROUND DATA:Data from numerous studies suggest that patient gender and ethnicity play a role in medical decision-making, with white males receiving more frequent interventions than women and minorities. METHODS:Patients enrolled for an "initial visit" in the National Spine Network database with lumbosacral level degenerative diagnosis were reviewed. Variables included patient gender, ethnicity, age, duration of symptoms, patient-graded severity of symptoms, radicular symptom pattern, and work status. RESULTS:We identified 5690 patients with degenerative lumbosacral pathologies. Although females were more likely than males to have imaging tests ordered, male (18.5%) patients were significantly more likely to have surgery recommended than female (16.3%) patients (P < 0.031). Nonwhite females were 52% less likely to have surgery offered at initial visit, as compared to white males (P < 0.005). More imaging tests were ordered or reviewed among whites (76.6%) than among any other ethnic group (P = 0.162). White (18.3%) and Asian (22.5%) patients were significantly more likely to have surgery recommended or prescribed than black (11.1%) and Hispanic (14.5) patients (P < 0.0001). CONCLUSIONS:This study suggests that ethnicity and gender affect the workup and surgical management of degenerative spinal disorders. However, it should be noted that there are a number of confounding factors not identified in the database, including managed care and insurance status and cultural differences, which may affect both test ordering and treatment recommendations. Further study of bias in clinical decision-making is indicated to assure equal delivery of quality care.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Taylor BA,Casas-Ganem J,Vaccaro AR,Hilibrand AS,Hanscom BS,Albert TJ

doi

10.1097/01.brs.0000152115.79236.6e

keywords:

subject

Has Abstract

pub_date

2005-02-01 00:00:00

pages

359-64

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-200502010-00018

journal_volume

pub_type

杂志文章,多中心研究

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Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background.