White patients report better results from spinal surgery than black patients

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A study published ahead of print in Spine has found, through a review of the SPORT (Spinal Patient Outcomes Research Trial) study, that white patients have significant improvements in physical function, bodily pain score, and the Oswestry Disability Index compared with black patients after spinal surgery.

Andrew Schoenfeld, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, USA, and colleagues reviewed data from the SPORT study for 2,427 patients who had undergone treatment (either surgical or non-surgical) for intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis. The large majority of patients were white (85%), with remaining patients being black (8%) or “other” (7%, not white and not black).


The aim of Schoenfeld
et al’s study was to assess the effect (if any) that race or ethnicity has on outcomes following spinal surgery. They explained that although studies have shown disparities in the quality and efficacy of healthcare offered to racial and ethical minorities with other medical interventions (eg, pacemaker implantation), there is limited research for disparities of care within orthopaedic medicine. However, what limited evidence is available suggests: “inequalities in spinal care for minority group similar to that encountered in other fields of medicine.”

 

At baseline, in Schoenfeld et al’s study, black patients were less likely to be married (p<0.001), employed (p<0.001), and less likely to have some form of higher education (p=0.006) than their white counterparts. Although there were no significant differences in incomes and age between the racial groups, blacks and others were more likely to be receiving or applying for worker’s compensation, welfare payments, or other compensation programmes (p<0.001) than whites. Other important differences were that blacks and others reported more severe symptoms and reduced functionality compared with whites, and significantly more black patients expressed a preference for non-surgical treatment than other racial groups (p<0.001). As a possible result of this preference, whites and others were significantly more likely to receive surgical treatment (p=0.003) than blacks.

 

Schoenfeld et al found that regardless of whether patients received surgical or non-surgical management, white patients reported better results than black patients. There were significant differences for physical function scores and significant differences in bodily pain scores between whites and blacks. They reported: “Similarly, there was a significant difference for surgical intervention for the Oswestry Disability Index between whites and blacks at two-, three-, and four-year evaluations, with significant differences in non-operative treatment identified at all time points. The greatest difference between whites and blacks were encountered for SF-36 bodily pain and physical function in the surgically treated groups at the four-year time point [36.7 vs. 26.8 (p=0.003) and 34.7 vs. 18.7 (p>0.001), respectively).”


However, despite these differences, there were no significant differences in treatment effect for primary outcome measures or self-rated progress between racial groups.

 

Schoenfeld et al reported: “Disparities in spinal care between racial and ethnic groups may result from numerous factors, including racially based obstacles resulting from education, social-cultural attitudes to healthcare, historical circumstances, and social-economic status. Further inequalities may result from healthcare segregation or a bias (whether conscious or subconscious) on the part of spine-care practitioners.” However, they added that the design of the SPORT study limited their potential to determine why these disparities exist and, in their study, the disparities did not “appear to be substantive qualitative disparities.”

 

They concluded: “Ultimately, more prospective must be conducted in order to define the true nature of spinal healthcare disparities within the United States, as well as the aetiologies behind its existence.”

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