Abstract
Objectives
Although studies have described inequities in spinal cord stimulation (SCS) receipt,
there is a lack of information to inform system-level changes to support health care
equity. This study evaluated whether Black patients exhaust more treatment options
than do White patients, before receiving SCS.
Materials and Methods
This retrospective cohort study included claims data of Black and non-Latinx White
patients who were active-duty service members or military retirees who received a
persistent spinal pain syndrome (PSPS) diagnosis associated with back surgery within
the US Military Health System, January 2017 to January 2020 (N = 8753). A generalized linear model examined predictors of SCS receipt within two
years of diagnosis, including the interaction between race and number of pain-treatment
types received.
Results
In the generalized linear model, Black patients (10.3% [8.7%, 12.0%]) were less likely
to receive SCS than were White patients (13.6% [12.7%, 14.6%]) The interaction term
was significant; White patients who received zero to three different types of treatments
were more likely to receive SCS than were Black patients who received zero to three
treatments, whereas Black and White patients who received >three treatments had similar
likelihoods of receiving a SCS.
Conclusions
In a health care system with intended universal access, White patients diagnosed with
PSPS tried fewer treatment types before receiving SCS, whereas the number of treatment
types tried was not significantly related to SCS receipt in Black patients. Overall,
Black patients received SCS less often than did White patients. Findings indicate
the need for structured referral pathways, provider evaluation on equity metrics,
and top-down support.
Graphical abstract
Graphical Abstract
Keywords
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Comment
Article info
Publication history
Published online: April 13, 2023
Accepted:
March 13,
2023
Received in revised form:
February 20,
2023
Received:
January 18,
2023
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: Funding for this project was provided by the Uniformed Services University through the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc under Cooperative Agreement no. HU00011920042.
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of the International Neuromodulation Society.
