Disparities in Provider Ordering Practices of Image-Guided Interventions and Surgery for Patients With Low Back Pain: A Cohort Study

Miriam E Peckham; Lubdha M Shah; Huong D Meeks; Alison Fraser; Carlos Galvao; Ghazaleh Safazadeh; Troy A Hutchins; Yoshimi Anzai; Julie M Fritz; Jacob Kean; Ruth C Carlos

doi:10.1016/j.jacr.2024.02.005

Disparities in Provider Ordering Practices of Image-Guided Interventions and Surgery for Patients With Low Back Pain: A Cohort Study

J Am Coll Radiol. 2024 Feb 17:S1546-1440(24)00191-1. doi: 10.1016/j.jacr.2024.02.005. Online ahead of print.

Authors

Affiliations

¹ Assistant Professor, Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah. Electronic address: Miriam.Peckham@hsc.utah.edu.
² Professor, Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
³ Assistant Professor, Department of Pediatrics, Critical Care Division, University of Utah Spencer F. Eccles School of Medicine, Salt Lake City, Utah.
⁴ Senior Database Manager, Utah Population Database, Pedigree and Population Resource, Salt Lake City, Utah.
⁵ Database Analyst, Utah Population Database, Salt Lake City, Utah.
⁶ Research Associate, Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁷ Associate Professor, Vice Chair of Clinical Operations, Department of Radiology at University of Utah, Salt Lake City, Utah.
⁸ Professor, Vice Chair for Quality and Safety, Department of Radiology at University of Utah School of Medicine, Salt Lake City, Utah.
⁹ Professor, Department of Physical Therapy & Athletic Training, University of Utah Health Sciences Center, Salt Lake City, Utah.
¹⁰ Associate Professor, Department of Population Health Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
¹¹ Professor, Department of Radiology, University of Michigan, Ann Arbor, Michigan; Editor-in-Chief of the JACR.

PMID: 38369043
DOI: 10.1016/j.jacr.2024.02.005

Abstract

Objective: To assess individual- and neighborhood-level sociodemographic factors associating with providers' ordering of nonpharmacologic treatments for patients with low back pain (LBP), specifically physical therapy, image-guided interventions, and lumbar surgery.

Methods: Our cohort included all patients diagnosed with LBP from 2000 to 2017 in a statewide database of all hospitals and ambulatory surgical facilities within Utah. We compared sociodemographic and clinical characteristics of (1) patients with LBP who received any treatment with those who received none and (2) patients with LBP who received invasive LBP treatments with those who only received noninvasive LBP treatments using the Student's t test, Wilcoxon's rank-sum tests, and Pearson's χ² tests, as applicable, and two separate multivariate logistic regression models: (1) to determine whether sociodemographic characteristics were risk factors for receiving any LBP treatments and (2) risk factors for receiving invasive LBP treatments.

Results: Individuals in the most disadvantaged neighborhoods were less likely to receive any nonpharmacologic treatment orders (odds ratio [OR] 0.74 for most disadvantaged, P < .001) and received fewer invasive therapies (0.92, P = .018). Individual-level characteristics correlating with lower rates of treatment orders were female sex, Native Hawaiian or other Pacific Islander race (OR 0.50, P < .001), Hispanic ethnicity (OR 0.77, P < .001), single or unmarried status (OR 0.69, P < .001), and no insurance or self-pay (OR 0.07, P < .001).

Conclusion: Neighborhood and individual sociodemographic variables associated with treatment orders for LBP with Area Deprivation Index, sex, race or ethnicity, insurance, and marital status associating with receipt of any treatment, as well as more invasive image-guided interventions and surgery.

Keywords: Ethnicity; image-guided interventions; insurance status; low back pain; neighborhood deprivation; race.