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United States Hospital Admissions for Lumbar Spinal Stenosis: Racial and Ethnic Differences, 2000 Through 2009

Skolasky, Richard L. ScD*; Maggard, Anica M. BS*; Thorpe, Roland J. Jr PhD; Wegener, Stephen T. PhD; Riley, Lee H. III MD*

doi: 10.1097/BRS.0b013e3182a3d392
Health Services Research

Study Design. Retrospective analysis of Nationwide Inpatient Sample and US Census data.

Objective. To (1) document national trends in surgical hospitalizations with the primary diagnosis of lumbar spinal stenosis from 2000 through 2009; and (2) evaluate how those trends relate to race and ethnicity.

Summary of Background Data. In the United States, the rate of lumbar spinal stenosis surgery is increasing, and understanding how changing demographic trends impact hospitalization rates for this surgery is important.

Methods. Multivariable regression models were used to determine associations between race and ethnicity and the rates of surgical hospitalization for lumbar spinal stenosis. All models were adjusted for age, sex, insurance, income status, geographical location, and comorbidities.

Results. From 2000 through 2009, the overall surgical hospitalization rate increased by 30%. Surgical hospitalization rates for lumbar spinal stenosis in the United States varied substantially across racial and ethnic groups. In 2009, white, non-Hispanics had the highest rate (1.074 per 1000) compared with black, non-Hispanics (0.558 per 1000; P< 0.001), and Hispanics (0.339 per 1000; P< 0.001). The relative differences persisted across time.

Conclusion. There were substantial differences in rates of surgical hospitalization among individuals of different racial and ethnic groups. Possible causes were (1) differences in clinical decision making among spine care providers with regard to offering surgical care to minority populations; (2) differences in access to care because of financial, educational, or geographical barriers; and (3) differences in attitudes toward surgical care among those of different racial and ethnic groups.

Level of Evidence: 3

The rate of surgical hospitalization for lumbar spinal stenosis increased from 2000 through 2009. Racial and ethnic group differences persisted. Minority populations had significantly lower hospitalization rates than Caucasians or non-Hispanics. Although underlying reasons are unclear, this finding may represent differences in clinical decision making, access to care, or treatment preferences.

Departments of *Orthopaedic Surgery

Health Policy and Management, and

Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Richard L. Skolasky, ScD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD; E-mail: ehenze1@jhmi.edu

Acknowledgment date: April 5, 2013. Revision date: June 20, 2013. Acceptance date: July 1, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants, patents, royalties, stocks.

© 2013 by Lippincott Williams & Wilkins