Racial differences in the use of lumbar spine radiographs: Results from the veterans health study

A. J. Selim, G. Fincke, X. S. Ren, Richard (Rick) Deyo, A. Lee, K. Skinner, L. Kazis

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Study Design. We analyzed data from the Veterans Health Study, a longitudinal study of male patients receiving VA ambulatory care. Objective. To determine whether clinical differences and/or race account for disparities between white and nonwhite patients in the use of lumbar spine radiographs. Summary and Background Data. Four hundred one patients with low back pain (LBP) receiving ambulatory care services in four VA outpatient clinics in the greater Boston area were followed for 12 months. Methods. Participants were mailed the Medical Outcome Study Short Form Health Survey (SF-36) and had scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising (SLR) test. Using self-reported racial data, patients were grouped as whites (315 patients) and nonwhites (among whom 22 were black, 4 nonwhite Hispanics, and 1 other race). Results. Nonwhite patients had lumbar spine films more often (13 of 27, 48%) than white patients (87 of 315, 27%)(P = 0.02). Nonwhite patients had higher pain intensity scores than white patients (63 ± 21 vs. 48 ± 21, P<0.01) and were more likely to have radiating leg pain (20 of 27, 76%; compared with 171 of 315, 55%; P = 0.01) than white patients. Nonwhite patients had worse physical functioning (P = 0.01), general health perception (P = 0.05), social functioning (P = 0.02), and role limitations because of emotional problems (P<0.01). At higher LBP intensity level, nonwhite patients received more lumbar spine films (20 of 27, 74%) than did white patients (155 of 315, 50%)(P <0.01). Among patients with positive SLR test, nonwhite patients also had lumbar spine films more often (5 of 22, 23%) than white patients (29 of 315, 11%) (P <0.01). However, after adjusting for multiple clinical characteristics, race was no longer found to be an independent predictor of lumbar spine radiograph use. A positive SLR test remained to be associated with higher radiograph use, whereas better mental health status was associated with lower radiograph use. Conclusions. There was greater use of lumbar spine radiographs by nonwhite patients compared with white patients. This remained true when patients were subcategorized by severity of LBP or SLR test. However, race had no influence when multiple clinical characteristics of the patients were controlled for simultaneously. This study demonstrates the importance of careful and comprehensive case-mix adjustment when assessing apparent differences in the use of medical services.

Original languageEnglish (US)
Pages (from-to)1364-1369
Number of pages6
JournalSpine
Volume26
Issue number12
DOIs
StatePublished - Jun 15 2001
Externally publishedYes

Fingerprint

Veterans Health
Spine
Leg
Motion Pictures
Low Back Pain
Ambulatory Care

Keywords

  • Case-mix
  • Health-related quality of life
  • Low back pain
  • Lumbar spine radiograph
  • Race
  • Sciatica

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Racial differences in the use of lumbar spine radiographs : Results from the veterans health study. / Selim, A. J.; Fincke, G.; Ren, X. S.; Deyo, Richard (Rick); Lee, A.; Skinner, K.; Kazis, L.

In: Spine, Vol. 26, No. 12, 15.06.2001, p. 1364-1369.

Research output: Contribution to journalArticle

Selim, A. J. ; Fincke, G. ; Ren, X. S. ; Deyo, Richard (Rick) ; Lee, A. ; Skinner, K. ; Kazis, L. / Racial differences in the use of lumbar spine radiographs : Results from the veterans health study. In: Spine. 2001 ; Vol. 26, No. 12. pp. 1364-1369.
@article{571dc49f38244d4dabb2d82c43f891e1,
title = "Racial differences in the use of lumbar spine radiographs: Results from the veterans health study",
abstract = "Study Design. We analyzed data from the Veterans Health Study, a longitudinal study of male patients receiving VA ambulatory care. Objective. To determine whether clinical differences and/or race account for disparities between white and nonwhite patients in the use of lumbar spine radiographs. Summary and Background Data. Four hundred one patients with low back pain (LBP) receiving ambulatory care services in four VA outpatient clinics in the greater Boston area were followed for 12 months. Methods. Participants were mailed the Medical Outcome Study Short Form Health Survey (SF-36) and had scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising (SLR) test. Using self-reported racial data, patients were grouped as whites (315 patients) and nonwhites (among whom 22 were black, 4 nonwhite Hispanics, and 1 other race). Results. Nonwhite patients had lumbar spine films more often (13 of 27, 48{\%}) than white patients (87 of 315, 27{\%})(P = 0.02). Nonwhite patients had higher pain intensity scores than white patients (63 ± 21 vs. 48 ± 21, P<0.01) and were more likely to have radiating leg pain (20 of 27, 76{\%}; compared with 171 of 315, 55{\%}; P = 0.01) than white patients. Nonwhite patients had worse physical functioning (P = 0.01), general health perception (P = 0.05), social functioning (P = 0.02), and role limitations because of emotional problems (P<0.01). At higher LBP intensity level, nonwhite patients received more lumbar spine films (20 of 27, 74{\%}) than did white patients (155 of 315, 50{\%})(P <0.01). Among patients with positive SLR test, nonwhite patients also had lumbar spine films more often (5 of 22, 23{\%}) than white patients (29 of 315, 11{\%}) (P <0.01). However, after adjusting for multiple clinical characteristics, race was no longer found to be an independent predictor of lumbar spine radiograph use. A positive SLR test remained to be associated with higher radiograph use, whereas better mental health status was associated with lower radiograph use. Conclusions. There was greater use of lumbar spine radiographs by nonwhite patients compared with white patients. This remained true when patients were subcategorized by severity of LBP or SLR test. However, race had no influence when multiple clinical characteristics of the patients were controlled for simultaneously. This study demonstrates the importance of careful and comprehensive case-mix adjustment when assessing apparent differences in the use of medical services.",
keywords = "Case-mix, Health-related quality of life, Low back pain, Lumbar spine radiograph, Race, Sciatica",
author = "Selim, {A. J.} and G. Fincke and Ren, {X. S.} and Deyo, {Richard (Rick)} and A. Lee and K. Skinner and L. Kazis",
year = "2001",
month = "6",
day = "15",
doi = "10.1097/00007632-200106150-00021",
language = "English (US)",
volume = "26",
pages = "1364--1369",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Racial differences in the use of lumbar spine radiographs

T2 - Results from the veterans health study

AU - Selim, A. J.

AU - Fincke, G.

AU - Ren, X. S.

AU - Deyo, Richard (Rick)

AU - Lee, A.

AU - Skinner, K.

AU - Kazis, L.

PY - 2001/6/15

Y1 - 2001/6/15

N2 - Study Design. We analyzed data from the Veterans Health Study, a longitudinal study of male patients receiving VA ambulatory care. Objective. To determine whether clinical differences and/or race account for disparities between white and nonwhite patients in the use of lumbar spine radiographs. Summary and Background Data. Four hundred one patients with low back pain (LBP) receiving ambulatory care services in four VA outpatient clinics in the greater Boston area were followed for 12 months. Methods. Participants were mailed the Medical Outcome Study Short Form Health Survey (SF-36) and had scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising (SLR) test. Using self-reported racial data, patients were grouped as whites (315 patients) and nonwhites (among whom 22 were black, 4 nonwhite Hispanics, and 1 other race). Results. Nonwhite patients had lumbar spine films more often (13 of 27, 48%) than white patients (87 of 315, 27%)(P = 0.02). Nonwhite patients had higher pain intensity scores than white patients (63 ± 21 vs. 48 ± 21, P<0.01) and were more likely to have radiating leg pain (20 of 27, 76%; compared with 171 of 315, 55%; P = 0.01) than white patients. Nonwhite patients had worse physical functioning (P = 0.01), general health perception (P = 0.05), social functioning (P = 0.02), and role limitations because of emotional problems (P<0.01). At higher LBP intensity level, nonwhite patients received more lumbar spine films (20 of 27, 74%) than did white patients (155 of 315, 50%)(P <0.01). Among patients with positive SLR test, nonwhite patients also had lumbar spine films more often (5 of 22, 23%) than white patients (29 of 315, 11%) (P <0.01). However, after adjusting for multiple clinical characteristics, race was no longer found to be an independent predictor of lumbar spine radiograph use. A positive SLR test remained to be associated with higher radiograph use, whereas better mental health status was associated with lower radiograph use. Conclusions. There was greater use of lumbar spine radiographs by nonwhite patients compared with white patients. This remained true when patients were subcategorized by severity of LBP or SLR test. However, race had no influence when multiple clinical characteristics of the patients were controlled for simultaneously. This study demonstrates the importance of careful and comprehensive case-mix adjustment when assessing apparent differences in the use of medical services.

AB - Study Design. We analyzed data from the Veterans Health Study, a longitudinal study of male patients receiving VA ambulatory care. Objective. To determine whether clinical differences and/or race account for disparities between white and nonwhite patients in the use of lumbar spine radiographs. Summary and Background Data. Four hundred one patients with low back pain (LBP) receiving ambulatory care services in four VA outpatient clinics in the greater Boston area were followed for 12 months. Methods. Participants were mailed the Medical Outcome Study Short Form Health Survey (SF-36) and had scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising (SLR) test. Using self-reported racial data, patients were grouped as whites (315 patients) and nonwhites (among whom 22 were black, 4 nonwhite Hispanics, and 1 other race). Results. Nonwhite patients had lumbar spine films more often (13 of 27, 48%) than white patients (87 of 315, 27%)(P = 0.02). Nonwhite patients had higher pain intensity scores than white patients (63 ± 21 vs. 48 ± 21, P<0.01) and were more likely to have radiating leg pain (20 of 27, 76%; compared with 171 of 315, 55%; P = 0.01) than white patients. Nonwhite patients had worse physical functioning (P = 0.01), general health perception (P = 0.05), social functioning (P = 0.02), and role limitations because of emotional problems (P<0.01). At higher LBP intensity level, nonwhite patients received more lumbar spine films (20 of 27, 74%) than did white patients (155 of 315, 50%)(P <0.01). Among patients with positive SLR test, nonwhite patients also had lumbar spine films more often (5 of 22, 23%) than white patients (29 of 315, 11%) (P <0.01). However, after adjusting for multiple clinical characteristics, race was no longer found to be an independent predictor of lumbar spine radiograph use. A positive SLR test remained to be associated with higher radiograph use, whereas better mental health status was associated with lower radiograph use. Conclusions. There was greater use of lumbar spine radiographs by nonwhite patients compared with white patients. This remained true when patients were subcategorized by severity of LBP or SLR test. However, race had no influence when multiple clinical characteristics of the patients were controlled for simultaneously. This study demonstrates the importance of careful and comprehensive case-mix adjustment when assessing apparent differences in the use of medical services.

KW - Case-mix

KW - Health-related quality of life

KW - Low back pain

KW - Lumbar spine radiograph

KW - Race

KW - Sciatica

UR - http://www.scopus.com/inward/record.url?scp=0035876635&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035876635&partnerID=8YFLogxK

U2 - 10.1097/00007632-200106150-00021

DO - 10.1097/00007632-200106150-00021

M3 - Article

C2 - 11426153

AN - SCOPUS:0035876635

VL - 26

SP - 1364

EP - 1369

JO - Spine

JF - Spine

SN - 0362-2436

IS - 12

ER -