Racial and health insurance disparities of inpatient spine augmentation for osteoporotic vertebral fractures from 2005 to 2010

C. N. Gu, Waleed Brinjikji, A. M. El-Sayed, H. Cloft, Jennifer S McDonald, David F Kallmes

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.

MATERIALS AND METHODS: Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using x2 tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use.

RESULTS: A total of 228,329 patients were included in this analysis, ofwhom129,206 (56.6%) received spine augmentation. Among patients with spine augmentation, 97,022 (75%) received kyphoplasty and 32,184 (25%) received vertebroplasty; 57.5% (92,779/161,281) of white patients received spine augmentation compared with 38.7% (1405/3631) of black patients (P < .001). Hispanic patients had significantly lower spine augmentation rates compared with white patients (52.3%, 3777/7222, P < .001) as did Asian/Pacific Islander patients (53.1%, 1784/3361, P<.001). The spine augmentation usage rate was 57.2% (114,768/200,662) among patients with Medicare, significantly higher than that of those with Medicaid (43.9%, 1907/4341, P < .001) and those who self-pay (40.2%, 488/1214, P < .001).

CONCLUSIONS: Our findings demonstrate substantial racial and health insurance- based disparities in the inpatient use of spinal augmentation for the treatment of osteoporotic vertebral fracture.

Original languageEnglish (US)
Pages (from-to)2397-2404
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume35
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

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Osteoporotic Fractures
Health Insurance
Inpatients
Spine
Kyphoplasty
Vertebroplasty
Insurance Coverage
Medicaid
International Classification of Diseases
Medicare
Hispanic Americans
Therapeutics
Back Pain
Health Status
Patient Care
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{1e7f40a0d0964f86a3886e32eacd6907,
title = "Racial and health insurance disparities of inpatient spine augmentation for osteoporotic vertebral fractures from 2005 to 2010",
abstract = "BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.MATERIALS AND METHODS: Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using x2 tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use.RESULTS: A total of 228,329 patients were included in this analysis, ofwhom129,206 (56.6{\%}) received spine augmentation. Among patients with spine augmentation, 97,022 (75{\%}) received kyphoplasty and 32,184 (25{\%}) received vertebroplasty; 57.5{\%} (92,779/161,281) of white patients received spine augmentation compared with 38.7{\%} (1405/3631) of black patients (P < .001). Hispanic patients had significantly lower spine augmentation rates compared with white patients (52.3{\%}, 3777/7222, P < .001) as did Asian/Pacific Islander patients (53.1{\%}, 1784/3361, P<.001). The spine augmentation usage rate was 57.2{\%} (114,768/200,662) among patients with Medicare, significantly higher than that of those with Medicaid (43.9{\%}, 1907/4341, P < .001) and those who self-pay (40.2{\%}, 488/1214, P < .001).CONCLUSIONS: Our findings demonstrate substantial racial and health insurance- based disparities in the inpatient use of spinal augmentation for the treatment of osteoporotic vertebral fracture.",
author = "Gu, {C. N.} and Waleed Brinjikji and El-Sayed, {A. M.} and H. Cloft and McDonald, {Jennifer S} and Kallmes, {David F}",
year = "2014",
month = "12",
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doi = "10.3174/ajnr.A4044",
language = "English (US)",
volume = "35",
pages = "2397--2404",
journal = "American Journal of Neuroradiology",
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TY - JOUR

T1 - Racial and health insurance disparities of inpatient spine augmentation for osteoporotic vertebral fractures from 2005 to 2010

AU - Gu, C. N.

AU - Brinjikji, Waleed

AU - El-Sayed, A. M.

AU - Cloft, H.

AU - McDonald, Jennifer S

AU - Kallmes, David F

PY - 2014/12/1

Y1 - 2014/12/1

N2 - BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.MATERIALS AND METHODS: Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using x2 tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use.RESULTS: A total of 228,329 patients were included in this analysis, ofwhom129,206 (56.6%) received spine augmentation. Among patients with spine augmentation, 97,022 (75%) received kyphoplasty and 32,184 (25%) received vertebroplasty; 57.5% (92,779/161,281) of white patients received spine augmentation compared with 38.7% (1405/3631) of black patients (P < .001). Hispanic patients had significantly lower spine augmentation rates compared with white patients (52.3%, 3777/7222, P < .001) as did Asian/Pacific Islander patients (53.1%, 1784/3361, P<.001). The spine augmentation usage rate was 57.2% (114,768/200,662) among patients with Medicare, significantly higher than that of those with Medicaid (43.9%, 1907/4341, P < .001) and those who self-pay (40.2%, 488/1214, P < .001).CONCLUSIONS: Our findings demonstrate substantial racial and health insurance- based disparities in the inpatient use of spinal augmentation for the treatment of osteoporotic vertebral fracture.

AB - BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.MATERIALS AND METHODS: Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using x2 tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use.RESULTS: A total of 228,329 patients were included in this analysis, ofwhom129,206 (56.6%) received spine augmentation. Among patients with spine augmentation, 97,022 (75%) received kyphoplasty and 32,184 (25%) received vertebroplasty; 57.5% (92,779/161,281) of white patients received spine augmentation compared with 38.7% (1405/3631) of black patients (P < .001). Hispanic patients had significantly lower spine augmentation rates compared with white patients (52.3%, 3777/7222, P < .001) as did Asian/Pacific Islander patients (53.1%, 1784/3361, P<.001). The spine augmentation usage rate was 57.2% (114,768/200,662) among patients with Medicare, significantly higher than that of those with Medicaid (43.9%, 1907/4341, P < .001) and those who self-pay (40.2%, 488/1214, P < .001).CONCLUSIONS: Our findings demonstrate substantial racial and health insurance- based disparities in the inpatient use of spinal augmentation for the treatment of osteoporotic vertebral fracture.

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JO - American Journal of Neuroradiology

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