41. Impact of insurance type on patient-reported outcome measures in patients with lumbar disc herniation

Abstract

<h3>BACKGROUND CONTEXT</h3> Lumbar disc herniations (LDH) are among the most common spinal conditions. Despite increased appreciation for the importance of social determinants of health, the role that these factors play in patients with lumbar disc herniations is poorly defined. <h3>PURPOSE</h3> To elucidate the association between insurance status and baseline patient-reported outcome measures (PROMs) in the setting of lumbar disc herniations. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Baseline patient-reported outcome measures (PROMS) were reviewed from 924 adult patients presenting for treatment of lumbar disc herniation within our institutional healthcare system (2015-2020). <h3>OUTCOME MEASURES</h3> The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analog scale (VAS) for back and leg pain were assessed. <h3>METHODS</h3> PROMIS scores at presentation were defined as the primary outcome and insurance status as the primary predictor. Differences in clinical and sociodemographic characteristics between our cohorts, stratified by insurance status, were evaluated using Wilcoxon rank-sum or chi-squared testing. We used multivariable negative binomial regression modeling to adjust for potential confounders including age, gender, race, language, ethnicity, comorbidity index, and median geospatial household income. Minimal clinically significant difference (MCID) was benchmarked using prior literature or the half-standard deviation derivation technique if no prior data were available. <h3>RESULTS</h3> We included 924 patients, with mean age of 58.4 +/- 15.2 years and 52.6% male prevalence. Patients insured through Medicaid were more likely to be Black, Hispanic, and non-English speaking patients compared with the commercially insured. The Charlson Comorbidity index was significantly higher in the Medicare group. Following adjusted analysis, patients with Medicaid insurance had significantly worse PF10a (IRR, 0.90, 95% CI 0.85 - 0.96), as well as PROMIS Global-Physical score (IRR 0.88, 95% CI 0.82 - 0.94), and VAS low back pain (IRR 1.20, 95% CI 1.04 - 1.40) when compared to the commercially insured. Unadjusted differences between groups met or exceeded MCID across both physical and mental domains. <h3>CONCLUSIONS</h3> We encountered worse physical function, mental and pain-related patient-reported outcomes for those with Medicaid insurance in a population of patients presenting for evaluation of lumbar disc herniation. These findings, including worse depression, anxiety and higher axial back pain scores may result from health system asymmetries and delayed, or suboptimal, access to care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.