Changes in racial and ethnic disparities in lumbar spinal surgery associated with the passage of the Affordable Care Act, 2006–2014 |
| |
| Authors: | Andrew Harris Sergio W Guadix Lee H Riley Amit Jain Khaled M Kebaish Richard L Skolasky |
| |
| Institution: | 1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA;2. Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA;1. The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA;3. State University of New York Upstate Medical University, 750 East Adams St, Syracuse, NY 13210-2375, USA;4. Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA;5. Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA;6. Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA;1. Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India;2. Ganga Research Centre, No 91, Mettupalayam Rd, Coimbatore 641030, India;3. Department of Plant Biotechnology, Tamil Nadu agricultural university, Coimbatore 641003, India;4. Aravind Medical Research Foundation, Madurai 625020, India;1. Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea;2. Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea;1. Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan;2. Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;3. Department of Medical Education, Taipei Veterans General Hospital, Taipei 11217, Taiwan;4. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;5. Research Center of Biostatistics, Taipei Medical University, Taipei 11031, Taiwan;6. Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;7. Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;8. Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan 70101, Taiwan;9. Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan;1. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands;2. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada;3. Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;5. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;6. Division of Surgery, McGill University and Montreal General Hospital, Montreal, Quebec, Canada;7. National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary;8. GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;9. Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada;10. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA;11. Department of Neurosurgery, The University of Kansas Hospital, Kansas City, KS, USA;12. Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA;13. Division of Spine, Department of Orthopedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada;14. Research Department, AOSpine International, Davos, Switzerland |
| |
| Abstract: | BACKGROUND CONTEXTSince implementation of the Patient Protection and Affordable Care Act (ACA) in 2010, more Americans have health insurance, and many racial/ethnic disparities in healthcare have improved. We previously reported that Black and Hispanic patients undergo surgery for spinal stenosis at lower rates than do white patients.PURPOSETo assess changes in racial/ethnic disparities in rates of lumbar spinal surgery after passage of the ACA.STUDY DESIGNRetrospective analysis.PATIENT SAMPLEApproximately 3.2 million adults who underwent lumbar spinal surgery in the US from 2006 through 2014.OUTCOME MEASURESRacial disparities in discharge rates before versus after ACA passage.METHODSUsing the Nationwide Inpatient Sample, the U.S. Census Bureau Current Population Survey Supplement, and International Classification of Diseases, Ninth Revision, Clinical Modification, criteria for definite lumbar spinal surgery, we calculated rates of lumbar spinal surgery as the number of hospital discharges divided by population estimates and stratified patients by race/ethnicity after controlling for sociodemographic characteristics. Calendar years were stratified as before ACA passage (2006–2010) or after ACA passage (2011–2014). Poisson regression was used to model hospital discharge rates as a function of race/ethnicity before and after ACA passage after adjustment for potential confounders.RESULTSAll rates are expressed per 1,000 persons. The overall median discharge rate decreased from 1.9 before ACA passage to 1.6 after ACA passage (p < .001). After adjustment for sociodemographic factors, the Black:White disparity in discharge rates decreased from 0.40:1 before ACA to 0.44:1 after ACA (p < .001). A similar decrease in the Hispanic:White disparity occurred, from 0.35:1 before ACA to 0.38:1 after ACA (p < .001).CONCLUSIONSmall but significant decreases occurred in racial/ethnic disparities in hospital discharge rates for lumbar spinal surgery after ACA passage. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
