Does Medicare Insurance Mitigate Racial/Ethnic Disparities in Access to Lumbar Spinal Surgery When Compared to Commercial Insurance?

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-08-01 Epub Date: 2024-02-19 DOI:10.1097/BSD.0000000000001576

Michael M Herrera, Justin Tiao, Ashley Rosenberg, Nicole Zubizarreta, Jashvant Poeran, Saad B Chaudhary

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Abstract

Study design: Retrospective cohort study.

Objective: Compare disparities in lumbar surgical care utilization in Commercially insured versus Medicare patients.

Summary of background data: While disparities in spinal surgery have been previously described, less evidence exists on effective strategies to mitigate them. Theoretically, universal health care coverage under Medicare should improve health care access.

Materials and methods: Utilizing National Inpatient Sample data (2003-2018), we included inpatient lumbar discectomy or laminectomy/fusion cases in black, white, or Hispanic patients aged 18-74 years, with Commercial or Medicare insurance. A multivariable Poisson distribution model determined race/ethnicity subgroup-specific rate ratios (RRs) of patients undergoing lumbar surgery compared to their respective population distribution (using US Census data) based on race/ethnicity, region, gender, primary payor, and age (Commercially insured age subgroups: 18-39, 40-54, and 55-64 y; Medicare age subgroup: 65-74 y).

Results: Of the 2,310,956 lumbar spine procedures included, 88.9%, 6.1%, and 5.0% represented white, black, and Hispanic patients, respectively. Among Commercially insured patients, black and Hispanic (compared to white) patients had lower rates of surgical care utilization; however, these disparities decreased with increasing age: black (RR=0.37, 95% CI: 0.37-0.38) and Hispanic patients (RR=0.53, 95% CI: 0.52-0.54) aged 18-39 years versus black (RR=0.72, 95% CI: 0.71-0.73) and Hispanic patients (RR=0.64, 95% CI: 0.63-0.65) aged 55-64 years. Racial/ethnic disparities persisted in Medicare patients, especially when compared to the neighboring age subgroup that was Commercially insured: black (RR=0.61, 95% CI: 0.60-0.62) and Hispanic patients (RR=0.61, 95% CI: 0.60-0.61) under Medicare.

Conclusions: Disparities in surgical care utilization among black and Hispanic patients persist regardless of health care coverage, and an expansion of Medicare eligibility alone may not comprehensively address health care disparities.

Level of evidence: Level III.

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与商业保险相比，医疗保险是否能减少腰椎手术治疗中的种族/族裔差异？

研究设计回顾性队列研究：比较商业保险患者与医疗保险患者在腰椎手术治疗利用率方面的差异：虽然脊柱外科手术中的差异以前就有描述，但关于缓解这些差异的有效策略的证据较少。从理论上讲，医疗保险下的全民医保应能改善医疗服务的可及性：利用全国住院病人抽样数据（2003-2018 年），我们纳入了住院腰椎间盘切除术或椎板切除术/融合术病例，患者为黑人、白人或西班牙裔，年龄在 18-74 岁之间，有商业保险或医疗保险。多变量泊松分布模型根据种族/人种、地区、性别、主要付款人和年龄（商业保险年龄亚组：18-39 岁、40-54 岁和 55-64 岁；医疗保险年龄亚组：65-74 岁），确定接受腰椎手术患者的种族/人种亚组特异性比率（RRs）与各自的人口分布（使用美国人口普查数据）：结果：在纳入的 2,310,956 例腰椎手术中，白人、黑人和西班牙裔患者分别占 88.9%、6.1% 和 5.0%。在参加商业保险的患者中，黑人和西语裔患者（与白人相比）的手术护理使用率较低；但是，随着年龄的增长，这些差异有所减小：18-39 岁的黑人（RR=0.37，95% CI：0.37-0.38）和西语裔患者（RR=0.53，95% CI：0.52-0.54）与55-64 岁的黑人（RR=0.72，95% CI：0.71-0.73）和西语裔患者（RR=0.64，95% CI：0.63-0.65）相比。医疗保险患者的种族/族裔差异依然存在，尤其是与商业保险的邻近年龄亚组相比：医疗保险下的黑人（RR=0.61，95% CI：0.60-0.62）和西班牙裔患者（RR=0.61，95% CI：0.60-0.61）：结论：无论医疗保险的覆盖范围如何，黑人和西班牙裔患者在手术治疗利用率方面的差距依然存在，仅扩大医疗保险的覆盖范围可能无法全面解决医疗差距问题：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.