Higher Socioeconomic Status is Associated with Greater Rates of Surgical Resource Utilization Prior to Spine Fusion Surgery

Abstract

Previous research has demonstrated an association between socioeconomic status (SES) and patient health, specifically noting that patients of lower SES have poor health outcomes. Understanding how social factors, including socioeconomic status (SES), relate to disparities in health outcomes is critical to closing gaps in equitable care to patients. While several studies have examined the effect of SES on postoperative spine outcomes, there is limited spine literature evaluating SES in the context of barriers to spine care. The primary objective of this study was to determine if socioeconomic status is associated with resource utilization prior to spine surgery consultation. As part of a sub-analysis, this paper also explores the effect of other social factors on pre-visit resource utilization. Retrospective cohort study. Adult patients who underwent elective cervical or lumbar spinal fusion between 2020 and 2021. Pre-visit resource utilization including 1) epidural steroid injection, 2) opioid use, 3) physical therapy, 4) prior spine surgeon, and 5) prior spine surgery METHODS: Each patient was assigned a "distressed score" using the Distressed Communities Index (DCI) and a socioeconomic status (SES) score using the Social Vulnerability Index (SVI) based on their zip code. Patient charts were manually reviewed to collect data regarding pre-visit resource utilization. The cohort was analyzed based on DCI quintile and SVI quartile. Additional analyses were conducted based on marital status and race. Our study included 996 patients in the final analysis. Based on DCI, patients from prosperous communities were more likely to have previously visited a spine surgeon (13.2% (prosperous) vs. 7.58% vs. 6.92% vs. 9.09% vs. 3.70% (distressed), p=0.015) and to have had prior spine surgery (11.1% (prosperous) vs. 9.57% vs. 9.09% vs. 2.52% vs. 6.36% (distressed), p=0.015). Similarly, when evaluated based on SES SVI, patients who lived in a low-risk community were more likely to have previously visited a spine surgeon (13.0% low-risk vs. 7.26% low-medium risk vs. 16.9% medium-high risk vs. 10.6% high risk, p=0.049) and to have had prior spine surgery (13.0% low-risk vs. 7.26% vs. 16.9% vs. 10.6% high risk, p=0.030). When evaluated based on marital status, there was no difference in any resource utilization. Non-black and non-white patients were more likely to have tried physical therapy compared to their black and white counterparts (76.9% (other) vs. 60.9% (Black) vs. 54.3% (White), p=0.026). This study examined the relationship between socioeconomic status and resource utilization and found a positive correlation between higher social standing and access to spine surgery and spine surgeons. These findings demonstrate a propensity for earlier evaluation of spine-related conditions among patients from prosperous communities compared to patients from less prosperous communities.