Lower Socioeconomic Status Associated with Higher Hospital Visits For Low Back Pain – Effect of Demographics on the Way Patients Seek Treatment

Introduction: There is limited literature on how patients progress through the healthcare system after presenting with low back pain (LBP). Given the existing literature on health disparities, this study explores the impact of socioeconomic status (SES), race, and gender on care patterns for LBP.

Methods: Utilizing a quaternary academic center’s health plan data, 35,922 claims from 15,221 adult patients between October 2021-March 2022 were analyzed. Recorded variables included race, gender, and Area Deprivation Index (ADI, proxy for socioeconomic status). Observed frequencies (O) were calculated as the absolute number of claims by a demographic (e.g., Caucasian, female) for a provider category divided by the total number of claims by that demographic. Expected frequencies (E) were measured if the demographic and provider category variables were independent. Log-linear models were fitted on contingency tables and residuals were examined to determine significant differences (p < 0.05) in observed and expected frequencies.

Results: There was no significant difference in claim numbers by race, gender, or ADI (higher scores indicating socioeconomic disadvantage). Chiropractic (33.94%), primary care (30.34%), and emergency (24.53%) medicine made up the bulk of the initial provider category. Individuals in higher ADI areas (ADI = 81-100) received initial services from emergency medicine more frequently than expected (O 27.22%, E 24.53%, p=0.003). Males were more likely to initially visit chiropractors (O 36.53%, E 33.94%, p=0.010). African-Americans were less likely to see chiropractors (O 12.31%, E 33.94%, p< 0.001) and utilized more emergency services (O 45.98%, E 24.53%, p< 0.001). Asians were less likely to utilize chiropractors (O 15.85%, E 33.94%, p< 0.001) but more likely to seek physical therapy (O 4.15%, E 1.26%, p=0.006). Caucasians utilized chiropractors more frequently (O 35.90%, E 33.94%, p< 0.001) while accessing emergency medicine less frequently (O 22.70%, E 24.53%, p< 0.001). Among subsequent visits, trends were similar.

Conclusion : Although the number of claims made by patients of different races, genders, and SES was similar, patients of high ADI were more likely to receive emergency services for LBP than their counterparts.