title: Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background.
abstract: METHODS
  Retrospective review comparing physician workup of degenerative lumbosacral pathologies between different genders and ethnic groups.
  
  
  OBJECTIVE
  To investigate whether patient ethnicity and gender influence the workup and treatment of degenerative spinal pathologies.
  
  
  BACKGROUND
  Data from numerous studies suggest that patient gender and ethnicity play a role in medical decision-making, with white males receiving more frequent interventions than women and minorities.
  
  
  METHODS
  Patients enrolled for an "initial visit" in the National Spine Network database with lumbosacral level degenerative diagnosis were reviewed. Variables included patient gender, ethnicity, age, duration of symptoms, patient-graded severity of symptoms, radicular symptom pattern, and work status.
  
  
  RESULTS
  We identified 5690 patients with degenerative lumbosacral pathologies. Although females were more likely than males to have imaging tests ordered, male (18.5%) patients were significantly more likely to have surgery recommended than female (16.3%) patients (P < 0.031). Nonwhite females were 52% less likely to have surgery offered at initial visit, as compared to white males (P < 0.005). More imaging tests were ordered or reviewed among whites (76.6%) than among any other ethnic group (P = 0.162). White (18.3%) and Asian (22.5%) patients were significantly more likely to have surgery recommended or prescribed than black (11.1%) and Hispanic (14.5) patients (P < 0.0001).
  
  
  CONCLUSIONS
  This study suggests that ethnicity and gender affect the workup and surgical management of degenerative spinal disorders. However, it should be noted that there are a number of confounding factors not identified in the database, including managed care and insurance status and cultural differences, which may affect both test ordering and treatment recommendations. Further study of bias in clinical decision-making is indicated to assure equal delivery of quality care.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. taylorb@msnotes.wustl.edu
authors.forename: Brett A
authors.initials: BA
authors.lastname: Taylor
authors.forename: Jorge
authors.initials: J
authors.lastname: Casas-Ganem
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: Brett S
authors.initials: BS
authors.lastname: Hanscom
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013122:Spinal Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data