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The Effect of Race on Outcomes of Surgical or Nonsurgical Treatment of Patients in the Spine Patient Outcomes Research Trial (SPORT)

Schoenfeld, Andrew J., MD*; Lurie, Jon D., MD, MS†,‡; Zhao, Wenyan, PhD‡,§; Bono, Christopher M., MD

doi: 10.1097/BRS.0b013e318251cc78
Health Services Research
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Study Design. Retrospective review of the data collected prospectively through the Spine Patient Outcomes Research Trial (SPORT).

Objective. To determine the effect that race or ethnicity had on outcomes after spine surgery in the 3 arms of SPORT.

Summary of Background Data. There is a dearth of research regarding the effect of race or ethnicity on outcome after treatment of spinal disorders.

Methods. All participants from the 3 arms of the SPORT were evaluated in an as-treated analysis, with patients categorized as white, black, or other. Baseline and operative characteristics of the groups were compared using the χ2 test and analysis of variance. Differences in the changes between baseline and 1-, 2-, 3-, and 4-year time points in the operative and nonoperative treatments were evaluated with a mixed effects longitudinal regression model, and differences between racial groups were compared with a multiple degrees of freedom Wald test.

Results. A total of 2427 patients (85% white, 8% black, and 7% other) were included. Surgery was performed on 67% of white patients, 54% of blacks, and 68% of others. Whites and others were significantly more likely to undergo surgery than blacks (67% and 68% vs. 54%, P = 0.003). Complications and the risk of additional surgeries were not significantly different between racial groups. Regardless of race, all patients improved more with surgical management than with nonoperative treatment for all outcome measures at all time points. The average 4-year area-under-the-curve results revealed surgical and nonoperative treatment resulted in statistically significant improvement in whites relative to blacks for SF-36 bodily pain (P < 0.001), physical function (P < 0.001), and Oswestry Disability Index (P < 0.001). No significant differences were noted in treatment effect for primary outcome measures or self-rated progress across racial groups.

Conclusion. These results illustrate important differences between racial groups in terms of response to spine care. Although there were quantitative differences between groups, these findings are not necessarily indications of health care disparities.

Participants from the 3 arms of the SPORT were evaluated in an as-treated analysis with patients categorized according to race/ethnicity. Although, all patients improved more with surgical management than with nonoperative treatment, white patients demonstrated statistically superior outcomes following surgical and nonoperative management when compared to blacks.

*Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX

Department of Medicine, Dartmouth Medical School, Lebanon, NH

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH

§Department of Orthopaedics, Dartmouth Medical School, Lebanon, NH

Spine Service, Department of Orthopaedics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Andrew J. Schoenfeld, MD, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 N. Piedras St., El Paso, TX 79920; E-mail: ajschoen@neoucom.edu or tamara.s.morgan@dartmouth.edu

Acknowledgment date: October 20, 2011. First revision date: January 5, 2012. Acceptance date: February 6, 2012.

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

National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444) and the Office of Research on Women's Health; National Institutes of Health; the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention funds were received to support this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.