Disparities in provider ordering practices of image-guided interventions and surgery for patients with low back pain: a cohort study.

OBJECTIVE: To assess individual- and neighborhood-level sociodemographic factors associating with providers' ordering of non-pharmacologic treatments for patients with low back pain (LBP), specifically physical therapy (PT), image-guided interventions (IGI), and lumbar surgery (LS).

METHODS: Our cohort included all patients diagnosed with LBP from 2000-2017 in a state-wide database of all hospitals and ambulatory surgical facilities within Utah. We compared sociodemographic and clinical characteristics of 1) LBP patients who received any treatment with those who received none, and 2) LBP patients who received invasive LBP treatments with those who only received non-invasive LBP treatments using the Student's t test, Wilcoxon rank sum tests and Pearson's chi-squared tests as applicable and two separate multivariate logistic regression models: 1) to determine whether sociodemographic characteristics were risk factors for receiving any LBP treatments and 2) risk factors for receiving invasive LBP treatments.

RESULTS: Individuals in the most disadvantaged neighborhoods were less likely to receive any non-pharmacologic treatment orders (OR 0.74 for most disadvantaged, p<0.001), and fewer invasive therapies (0.92, p=0.018). Individual-level characteristics correlating with lower rates of treatment orders were female sex, Native Hawaiian or other Pacific Islander race (OR 0.50, p<0.001), Hispanic ethnicity (OR 0.77, p<0.001), single/unmarried status (OR 0.69, p<0.001), and no insurance/self-pay (OR 0.07, p<0.001).

CONCLUSION: Neighborhood and individual sociodemographic variables associated with treatment orders for LBP with ADI, sex, race/ethnicity, insurance and marital status associating with receipt of any treatment, as well as more invasive image-guided interventions and surgery.