Associations of race and ethnicity with patient-reported outcomes and health care utilization among older adults initiating a new episode of care for back pain

Carlo J. Milani, Sean D. Rundell, Jeffrey G. Jarvik, Janna Friedly, Patrick J. Heagerty, Andy Avins, David Nerenz, Laura S. Gold, Judith A. Turner, Thiru Annaswamy, Srdjan S. Nedeljkovic, Pradeep Suri

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Study Design. Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. Objective. To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for BP. Summary of Background Data. No prior longitudinal studies have characterized associations between multiple race/ethnicity groups, and BP-related PROs and health care utilization in the United States. Methods. This study included 5117 participants ≥65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site. Results. Baseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P<0.001). Participants in all race/ethnicity groups showed statistically significant, but modest improvements in BP over 24 months. Blacks and Hispanics did not have statistically significant improvement in BP-related functional limitations over time, unlike whites, Asians, and non-Hispanics; however, the magnitude of differences in improvement between groups was small. Blacks had less spine-related health care utilization over 24 months than whites (spine-related RVU ratio of means 0.66, 95% confidence interval [CI] 0.51-0.86). Hispanics had less spine-related health care utilization than non-Hispanics (spine-related RVU ratio of means 0.60; 95% CI 0.40-0.90). Conclusion. Blacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. Residual confounding may explain some of the association between race/ethnicity and health outcomes. Further studies are needed to understand the factors underlying these differences and which differences reflect disparities. Level of Evidence: 3 .

Original languageEnglish (US)
Pages (from-to)1007-1017
Number of pages11
Issue number14
Publication statusPublished - Jul 15 2018



  • Asian
  • black
  • disability
  • disparity
  • ethnicity
  • functional limitation
  • Hispanic
  • low back pain
  • older adults
  • race
  • utilization

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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