P78. Socioeconomic and community disparities in presenting physical functionality and mental distress characteristics of patients undergoing spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Timeliness of care, providers' ability to identify and treat a problem, is one of the Institute of Medicine's six key priorities. When timeliness is compromised, patients experience greater distress and incur higher treatment expenses. Black patients and low-income patients are more likely to never get care when compared to their White and high-income counterparts. <h3>PURPOSE</h3> To examine the effect of socioeconomic disparities on functional and mental health impairment upon indication for spine surgery. To discern the impact of presenting physical impairment on 90D postop, patient reported outcomes. <h3>STUDY DESIGN/SETTING</h3> This prospective study was conducted within the University of Pennsylvania Health System (UPHS), a tertiary care, referral center. <h3>PATIENT SAMPLE</h3> Inclusion criteria included patients (N=855) who were 18 years or older and visited a clinician within UPHS for spinal surgery between November 1, 2018 and August 1, 2019. Patients must have had a self-reported, Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score, a PROMIS Global Mental Health (GPH) score, and a Visual Analog Scale (VAS) pain score at the time of presentation as well as PROMIS GPH and GMH scores at 90D postop. <h3>OUTCOME MEASURES</h3> (1-3) Preop VAS pain score; PROMIS GPH score; PROMIS GMH score; (4-5) 90D postop PROMIS GPH, GMH scores. <h3>METHODS</h3> Higher PROMIS scores indicate a better, health-related quality of life/functionality and higher VAS scores indicate greater subjective pain. Chi Square analysis, one-way analysis of variance (ANOVA), and Kruskal-Wallis analyses were utilized as appropriate with Bonferroni's and Dunn's post-hoc tests for multiple comparisons. A multivariable linear regression model was constructed to quantify the degree to which a patient's presenting PROMIS Global Physical Health (GPH) score was related to clinical predictors. <h3>RESULTS</h3> The cohort was stratified into socioeconomic (SES) quartiles based on the median household income of a patient's zip code. The highest SES White patients had mental health PROMIS scores that were 21.4% higher, or improved, when compared to the lowest SES White patients (P<0.0001), and the highest SES Black/African-American patients had median mental health PROMIS scores that were 30% higher than the lowest SES Black/African-American patients (P=0.0049). When compared to the highest quartile of PROMIS GPH Scores (GPH =14+), patients who reported GPH scores in the lowest quartile (Score= 1-8), resided in communities where the median household income was 26% lower (P<0.0001) and had 10.7% higher population per primary care provider (P=0.0031). Additionally, at 90D postop, patients who reported initial GPH scores in the lowest quartile reported postop GMH scores that were 36.8%(P<0.0001) worse and GPH(P<0.0001) scores 37.5% worse when compared to highest quartile of presenting PROMIS GPH Scores (GPH =14+). Black/African-American Race (B = -1.011, P=0.012), lower access to health care within a zip code (B = -1.616, P<0.0001), and low SES patients (B = -1.504, P=0.001) were independent drivers of worsened presenting PROMIS GPH Scores. <h3>CONCLUSIONS</h3> Our findings endorse the notion that Black/African-American patients and socioeconomically disadvantaged patients may present with more severe baseline pathology due, in part, to structural barriers such as inadequate access to care which in turn, adversely affect their postoperative trajectories. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.