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Kabangu JLK, Heskett CA, De Stefano FA, Masri-Elyafaoui A, Fry L, Ohiorhenuan IE. Race and socioeconomic disparities persist in treatment and outcomes of patients with cervical spinal cord injuries: An analysis of the national inpatient sample from 2016 - 2020. World Neurosurg X 2024; 23:100384. [PMID: 38725975 PMCID: PMC11078697 DOI: 10.1016/j.wnsx.2024.100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
Objective Previous literature has described race and socioeconomic disparities in both treatment and outcomes following cervical spinal cord injuries (SCI). The goal of this study is to investigate the current state of parity in management and outcomes following SCI. Methods We surveyed the National Inpatient Sample database (NIS) for patients admitted with primary diagnosis of cervical SCI. 49,320 patients were identified. Univariate and multivariate analyses were performed to evaluate racial and socioeconomic differences in SCI care and outcomes. Results Compared to white patients, minority race was associated with a longer time from presentation to operative intervention (p < 0.001) and longer length of stay following admission for cervical SCI (16 vs 13 days, p < 0.001). Minority patients were more likely to have an unfavorable discharge (skilled nursing facility, against medical advice, death) status than white patients (p < 0.001). Patients in the bottom quartile of median household income were associated with more unfavorable discharges than the top two quartiles (p < 0.001). Patients with the lowest median household income quartile also had higher total costs than those in the top quartiles ($221,654 vs 191,723, p < 0.001). Black, Hispanic, and Asian/Pacific Islander incurred higher treatment costs than White patients. Conclusion Minority and lower socioeconomic status are independently associated with unfavorable discharge and LOS in cervical SCI. Furthermore, racial and economically disadvantaged groups have longer wait times from admission to surgical intervention. These disparities persist despite being highlighted by previous publications and increased societal awareness of healthcare inequities, necessitating further work to reach parity.
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Affiliation(s)
- Jean-Luc K. Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Cody A. Heskett
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Frank A. De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ahmad Masri-Elyafaoui
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ifije E. Ohiorhenuan
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Noh SH, Lee E, Kim KT, Kim SH, Cho PG. Traumatic spinal cord injury in South Korea for 13 years (2008-2020). Sci Rep 2024; 14:8290. [PMID: 38594283 PMCID: PMC11004143 DOI: 10.1038/s41598-024-57965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024] Open
Abstract
Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.
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Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eunyoung Lee
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Hyun Kim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea
| | - Pyung Goo Cho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea.
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Raso J, Kamalapathy P, Solomon E, Driskill E, Kurker K, Joshi A, Hassanzadeh H. Increased Time to Fixation After Traumatic Spinal Cord Injury Influenced by Race and Insurance Status. Global Spine J 2024:21925682231225175. [PMID: 38317534 DOI: 10.1177/21925682231225175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Although the optimal timing of surgical intervention for traumatic spinal cord injury (TSCI) is controversial, early intervention has been recognized as being beneficial in several studies. The objective of this study was to evaluate the socioeconomic factors that may delay time to surgical fixation in the management of TSCI. METHODS The present study utilized the Trauma Quality Improvement Program (TQIP) dataset to identify patients aged greater than 18 undergoing spinal fusion for TSCI from 2007-2016. Patients were divided into subgroups based on race and insurance types. Multivariable linear regression was used to compare time to procedure based on race and payer type while adjusting for demographic and injury-specific factors. Significance was set at P < .05. RESULTS Using multivariable analysis, Hispanic and Black patients were associated with significantly increased time to fixation of 12.1 h (95% CI 5.5-18.7, P < .001), and 20.1 h (95% CI 12.1-28.1, P < .001), respectively compared to White patients. Other cohorts based on racial status did not have significantly different times to fixation (P > .05). Medicaid was associated with an increased time to fixation compared to private insurance (11.6 h, 95% CI 3.9-19.2, P = .003). CONCLUSIONS Black and Hispanic race and Medicaid were associated with statistically significant increases in time to fixation following TSCI, potentially compromising quality of patient care and resulting in poorer outcomes. More research is needed to elucidate this relationship and ensure equitable care is being delivered.
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Affiliation(s)
- Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eric Solomon
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
| | | | - Kristina Kurker
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya Joshi
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
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Balas M, Jaja BNR, Harrington EM, Jack AS, Hofereiter J, Malhotra AK, Jaffe RH, He Y, Byrne JP, Wilson JR, Witiw CD. Earlier Tracheostomy Reduces Complications in Complete Cervical Spinal Cord Injury in Real-World Practice: Analysis of a Multicenter Cohort of 2001 Patients. Neurosurgery 2023; 93:1305-1312. [PMID: 37341486 DOI: 10.1227/neu.0000000000002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is believed that early tracheostomy in patients with traumatic cervical spinal cord injury (SCI) may lessen the risk of developing complications and reduce the duration of mechanical ventilation and critical care stay. This study aims to assess whether early tracheostomy is beneficial in patients with traumatic cervical SCI. METHODS We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program database from 2010 to 2018. Adult patients with a diagnosis of acute complete (ASIA A) traumatic cervical SCI who underwent surgery and tracheostomy were included. Patients were stratified into those receiving early (at or before 7 days) and delayed tracheostomy. Propensity score matching was used to assess the association between delayed tracheostomy and the risk of in-hospital adverse events. Risk-adjusted variability in tracheostomy timing across trauma centers was investigated using mixed-effects regression. RESULTS The study included 2001 patients from 374 North American trauma centers. The median time to tracheostomy was 9.2 days (IQR: 6.1-13.1 days), with 654 patients (32.7%) undergoing early tracheostomy. After matching, the odds of a major complication were significantly lower for early tracheostomy patients (OR: .90; 95% CI: .88-.98). Patients were also significantly less likely to experience an immobility-related complication (OR: .90; 95% CI: .88-.98). Patients in the early group spent 8.2 fewer days in the critical care unit (95% CI: -10.2 to -6.61) and 6.7 fewer days ventilated (95% CI: -9.44 to -5.23). There was significant variability in tracheostomy timeliness between trauma centers with a median odds ratio of 12.2 (95% CI: 9.7-13.7), which was not explained by case-mix and hospital-level characteristics. CONCLUSION A 7-day threshold to implement tracheostomy seems to be associated with reduced in-hospital complications, time in the critical care unit, and time on mechanical ventilation.
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Affiliation(s)
- Michael Balas
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Blessing N R Jaja
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
| | - Erin M Harrington
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Andrew S Jack
- Division of Neurosurgery, University of Alberta, Edmonton , Alberta , Canada
| | - Johann Hofereiter
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Rachael H Jaffe
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
| | - Yingshi He
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - James P Byrne
- Department of Surgery, Johns Hopkins Hospital, Baltimore , Maryland , USA
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
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Sun J, Yuan W, Zheng R, Zhang C, Guan B, Ding J, Chen Z, Sun Q, Fu R, Chen L, Zhou H, Feng S. Traumatic spinal injury-related hospitalizations in the United States, 2016-2019: a retrospective study. Int J Surg 2023; 109:3827-3835. [PMID: 37678281 PMCID: PMC10720809 DOI: 10.1097/js9.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain unclear. MATERIALS AND METHODS An adult population was selected from the National Inpatient Sample database from 2016 to 2019. TSI incidence was calculated and TSI-related hospitalizations were divided into operative and nonoperative groups according to the treatments received. TSIs were classified as fracture, dislocation, internal organ injury, nerve root injury, or sprain injuries based on their nature. The annual percentage change (APC) was calculated to identify trends. In-hospital deaths were utilized to evaluate the prognosis of different TSIs. RESULTS Overall, 95 047 adult patients were hospitalized with TSI in the US from 2016 to 2019, with an incidence rate of 48.4 per 100 000 persons in 2019 (95% CI: 46.2-50.6). The total incidence increased with an APC of 1.5% (95% CI: 0.1-3%) from 2016 to 2019. Operative TSI treatment was more common than nonoperative (32.8 vs. 3.8; 95% CI: 32.3-33.2 vs. 3.6-4%). The number of operations increased from 37 555 (95% CI: 34 674-40 436) to 40 460 (95% CI: 37 372-43 548); however, the operative rate only increased for internal organ injury (i.e. spinal cord injury [SCI])-related hospitalizations (APC, 3.6%; 95% CI: 2.8-4.4%). In-hospital mortality was highest among SCI-related hospitalizations, recorded at 3.9% (95% CI: 2.9-5%) and 28% (95% CI: 17.9-38.2%) in the operative and nonoperative groups, respectively. CONCLUSIONS The estimated incidence of TSI in US adults increased from 2016 to 2019. The number of operations increased; however, the proportion of operations performed on TSI-related hospitalizations did not significantly change. In 2019, SCI was the highest associated mortality TSI, regardless of operative or nonoperative treatment.
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Affiliation(s)
- Jiuxiao Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Wenjian Yuan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Ruiyuan Zheng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Chi Zhang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Bin Guan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Jiaming Ding
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Zhuo Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Qingyu Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Runhan Fu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Lingxiao Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
- Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, Australia
| | - Hengxing Zhou
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
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Furlan JC. Racial and Ethnical Discrepancies and Similarities in the Epidemiology, Survival, and Neurological Outcomes After Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study Using Data from the NASCIS-1 Trial. Top Spinal Cord Inj Rehabil 2023; 29:88-102. [PMID: 38174140 PMCID: PMC10759859 DOI: 10.46292/sci23-00055s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Little is known about the impact of race/ethnicity on the clinical and neurological outcomes after acute traumatic spinal cord injury (tSCI). Objectives This study examined the influence of race/ethnicity on the individuals' survival and neurological recovery within the first year after tSCI. Methods The 306 cases enrolled in the First National Acute Spinal Cord Injury Study (NASCIS-1) were grouped as African American individuals (n = 84), non-Hispanic White individuals (n = 159), and other races/ethnicities that included Hispanic individuals (n = 60) and Asian individuals (n = 3). Outcome measures included survival and neurological recovery within the first year after tSCI. Data analyses were adjusted for major potential confounders. Results There were 39 females and 267 males with mean age of 31 years who mostly sustained cervical severe tSCI after motor vehicle accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. African American individuals were significantly older than non-Hispanic White individuals (p = .0238). African American individuals and individuals of other races/ethnicities more often had a tSCI with open wound caused by missile and water-related accidents than non-Hispanic White individuals (p < .0001). Survival rates within the first year after tSCI were comparable among the three groups (p = .3191). Among the survivors, there were no significant differences among the three groups regarding motor and pinprick and light-touch sensory recovery (p > .0500). Conclusions The results of this study suggest that, while there were few differences among the racial/ethnical groups regarding the epidemiology of tSCI, race/ethnicity did not influence survival rate or neurological recovery within the first year post-tSCI.
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Affiliation(s)
- Julio C. Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Rubery PT, Ramirez G, Kwak A, Thirukumaran C. Racial/ethnic and income-based differences in the use of surgery for cervical and lumbar disorders in New York State: a retrospective analysis. Spine J 2023:S1529-9430(23)03465-4. [PMID: 37890728 DOI: 10.1016/j.spinee.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND CONTEXT The extent to which use of spine surgeries for patients with cervical and lumbar disorders varies by their race/ethnicity and income is currently unknown. PURPOSE To assess racial/ethnic and income-based differences in use of spine surgery in New York State (NYS) from 2016 to 2019. STUDY DESIGN Retrospective observational analysis using 2016 to 2019 New York Statewide Planning and Research Cooperative System (SPARCS) data, direct standardization, and multivariable mixed-effects linear regression models. METHODS A dataset of patients who underwent surgery for cervical and spinal disorders in NYS in the period 2016 to 2019 was used to determine county-level age- and sex-standardized annual cervical and lumbar surgery rates expressed as number of surgeries per 10,000 individuals. Further sub-analysis was performed with the key independent variables being the combination of individual-level race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic individuals) and income (low-/high-income residing in zip codes below/above state median income); and year. We estimated multivariable mixed-effects linear regression models which controlled county-level variables to determine the adjusted rates of spine surgeries for patients belonging to various race/ethnicity and income group combinations. RESULTS The study included 29,650 and 42,498 patients in the cervical and lumbar cohorts, respectively. In 2019, the county-level mean cervical and lumbar surgery rates were 3.88 and 5.19 surgeries per 10,000 individuals, respectively. There was a five-fold rate variation across NYS. In 2019, the adjusted cervical rates were 4.59 (White low-income), 4.96 (White high-income), 7.20 (Black low-income), 3.01 (Black high-income), 4.37 (Hispanic low-income), and 1.17 (Hispanic high-income). The adjusted lumbar rates were 5.49 (White low-income), 6.31 (White high-income), 9.43 (Black low-income), 2.47 (Black high-income), 4.22 (Hispanic low-income), and 2.02 (Hispanic high-income). The rates for low-income Black or Hispanic patients were significantly higher than their high-income counterparts. Low-income Black patients had the highest rates. Over the study period, the gap/difference increased significantly between high-income Hispanic and White individuals by 2.19 (95% confidence interval [CI]: -4.27, -0.10, p=.04) for cervical surgery; and between low-income Black and White individuals by 2.82 (2.82, 95% CI: 0.59, 5.06, p=.01) for lumbar surgery. CONCLUSION There are differences in the rates of spine surgery in New York State, among identifiable groups. Black individuals from poorer zip codes experience relatively higher spine surgery rates. Understanding the drivers of surgical rate variation is key to improving the equitable delivery of spine care. A better understanding of such rate variations could inform health policy.
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Affiliation(s)
- Paul T Rubery
- Department of Orthopaedics - University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA; Center for Musculoskeletal Research - University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA.
| | - Gabriel Ramirez
- Department of Orthopaedics - University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA; Center for Musculoskeletal Research - University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Amelia Kwak
- University of Rochester, 500 Joseph C. Wilson Blvd., Rochester, NY 14627, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics - University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA; Center for Musculoskeletal Research - University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Department of Public Health Sciences - University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
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Dhanjani SA, Schmerler J, Wenzel A, Gomez G, Oni J, Hegde V. Racial and Socioeconomic Disparities in Risk and Reason for Revision in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:e815-e823. [PMID: 37276485 DOI: 10.5435/jaaos-d-22-01124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Data regarding racial/ethnic and socioeconomic differences in revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) have been inconsistent. This study examined racial/ethnic and socioeconomic disparities in comorbidity-adjusted risk and reason for rTHA and rTKA. METHODS Patients who underwent rTHA or rTKA between 2006 and 2014 in the National Inpatient Sample were identified. Multivariable logistic regression models adjusted for payer status, hospital geographic setting, and patient characteristics (age, sex, and Elixhauser Comorbidity Index) were used to examine the effect of race/ethnicity and socioeconomic status on trends in annual risk of rTHA/rTKA and causes of rTHA/rTKA. RESULTS Black patients were less likely to undergo rTHA and more likely to undergo rTKA while Hispanic patients were more likely to undergo rTHA and less likely to undergo rTKA ( P < 0.001 for all) compared with White patients. Patients residing in areas of lower income quartiles were more likely to undergo rTHA and rTKA compared with those in the highest quartile ( P < 0.001), and these disparities persisted and widened over time. Black, Hispanic, and Asian patients were less likely to undergo rTHA/rTKA because of dislocation compared with White patients ( P < 0.001 for all). Patients from areas of lower income quartiles were more likely to undergo rTHA because of septic complications and less likely to require both rTHA and rTKA because of mechanical complications ( P < 0.001 for all). DISCUSSION Racial/ethnic and socioeconomic disparities exist in risk and cause of rTHA and rTKA. Increasing awareness and a focus on minimizing variability in hospital quality may help mitigate these disparities.
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Affiliation(s)
- Suraj A Dhanjani
- From the Johns Hopkins University School of Medicine, Baltimore, MD (Dhanjani, Schmerler, and Gomez), and the Department of Orthopaedic Surgery, (Dr. Wenzel, Dr. Oni, Dr. Hegde), The Johns Hopkins University School of Medicine, Baltimore, MD (Wenzel, Oni, and Hegde)
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Boden-Albala B, Rebello V, Drum E, Gutierrez D, Smith WR, Whitmer RA, Griffith DM. Use of Community-Engaged Research Approaches in Clinical Interventions for Neurologic Disorders in the United States: A Scoping Review and Future Directions for Improving Health Equity Research. Neurology 2023; 101:S27-S46. [PMID: 37580148 DOI: 10.1212/wnl.0000000000207563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence suggests a significant prevalence of race and ethnic disparities in the United States among people with neurologic conditions including stroke, Alzheimer disease and related dementia (ADRD), Parkinson disease (PD), epilepsy, spinal cord injury (SCI), and traumatic brain injury (TBI). Recent neurologic research has begun the paradigm shift from observational health disparities research to intervention research in an effort to narrow the disparities gap. There is an evidence base that suggests that community engagement is a necessary component of health equity. While the increase in disparities focused neurologic interventions is encouraging, it remains unclear whether and how community-engaged practices are integrated into intervention design and implementation. The purpose of this scoping review was to identify and synthesize intervention studies that have actively engaged with the community in the design and implementation of interventions to reduce disparities in neurologic conditions and to describe the common community engagement processes used. METHODS Two databases, PubMed and CINAHL, were searched to identify eligible empirical studies within the United States whose focus was on neurologic interventions addressing disparities and using community engagement practices. RESULTS We identified 392 disparity-focused interventions in stroke, ADRD, PD, epilepsy, SCI, and TBI, of which 53 studies incorporated community engagement practices: 32 stroke studies, 15 ADRD, 2 epilepsy studies, 2 PD studies, 1 SCI study, and 1 TBI study. Most of the interventions were designed as randomized controlled trials and were programmatic in nature. The interventions used a variety of community engagement practices: community partners (42%), culturally tailored materials and mobile health (40%), community health workers (32%), faith-based organizations and local businesses (28%), focus groups/health need assessments (25%), community advisory boards (19%), personnel recruited from the community/champions (19%), and caregiver/social support (15%). DISCUSSION Our scoping review reports that the proportion of neurologic intervention studies incorporating community engagement practices is limited and that the practices used within those studies are varied. The major practices used included collaboration with community partners and utilization of culturally tailored materials. We also found inconsistent reporting and dissemination of results from studies that implemented community engagement measures in their interventions. Future directions include involving the community in research early and continuously, building curricula that address challenges to community engagement, prioritizing the inclusion of community engagement reporting in peer-reviewed journals, and prioritizing and incentivizing research of subpopulations that experience disparities in neurologic conditions.
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Affiliation(s)
- Bernadette Boden-Albala
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC.
| | - Vida Rebello
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Emily Drum
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Desiree Gutierrez
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Wally R Smith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Rachel A Whitmer
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Derek M Griffith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
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10
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Mo K, Ikwuezunma I, Mun F, Ortiz-Babilonia C, Wang KY, Suresh KV, Uppal A, Sethi I, Mesfin A, Jain A. Racial Disparities in Spine Surgery: A Systematic Review. Clin Spine Surg 2023; 36:243-252. [PMID: 35994052 DOI: 10.1097/bsd.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To synthesize previous studies evaluating racial disparities in spine surgery. METHODS We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses guidelines and protocol. The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions, and length of stay. RESULTS A total of 1753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Whites (Ws) and African Americans (AAs) groups; 14 studies reported adverse outcomes for AAs. When compared with Ws, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition, and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy, and were less likely to receive cervical disk arthroplasty compared with Ws for similar indications. CONCLUSIONS This systematic review of spine literature found that when compared with W patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Ijezie Ikwuezunma
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Kevin Y Wang
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | | | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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11
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Devlin VJ, Jean R, Peat CR, Jiang H, Anderson PA, Benson JC, Brodke DS, Golish SR, Kebaish KM, Larson AN, Serhan H. Summary of the FDA virtual public workshop on spinal device clinical review held on September 17, 2021. Spine J 2022; 22:1423-1433. [PMID: 35460900 DOI: 10.1016/j.spinee.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
The mission of Food and Drug Administration (FDA)'s Center for Devices and Radiological Health is to protect and promote public health. It assures that patients and providers have timely and continued access to safe, effective, and high-quality medical devices and safe radiation-emitting products by providing meaningful and timely information about the products we regulate and the decisions we make. On September 17, 2021, an FDA workshop was held to provide information to stakeholders, including members of the spine community, device manufacturers, regulatory affairs professionals, clinicians, patients, and the general public regarding FDA regulations, guidance and regulatory pathways related to spinal device clinical review. It was not intended to communicate any new policies, processes, or interpretations regarding medical device marketing authorizations. This workshop consisted of individual presentations, group discussions, question and answer sessions, and audience surveys. Information-sharing included discussions related to patient-reported outcomes, clinician-reported outcomes, observer-reported outcomes, and performance outcomes. Discussions involving external subject matter experts covered topics related to spinal device clinical studies including definition of a target population, enrollment criteria, strategies for inclusion of under-represented patient groups, reporting of adverse event and secondary surgical procedures, clinical study endpoints, and clinical outcome assessments. A meeting transcript and webcast workshop link are currently posted on the FDA website. Important related issues and challenges were discussed, and an exciting range of new ideas and concepts were shared which hold promise to advance regulatory science, patient care and future innovation related to spinal devices.
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Affiliation(s)
- Vincent J Devlin
- Office of Health Technology-6: Office of Orthopedic Devices, Office of Product Evaluation and Quality, CDRH
- Food and Drug Administration, White Oak, Bldg 66, Rm 4450, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Ronald Jean
- DHT6B: Division of Spinal Devices, OHT6: Office of Orthopedic Devices, Office of Product Evaluation and Quality, CDRH
- Food and Drug Administration, White Oak, Bldg. 66, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Capt Raquel Peat
- OHT6: Office of Orthopedic Devices, Office of Product Evaluation and Quality, CDRH
- Food and Drug Administration, White Oak, Bldg 66, Rm 4444, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Hongying Jiang
- OHT6: Office of Orthopedic Devices, Office of Product Evaluation and Quality, CDRH
- Food and Drug Administration, White Oak, Bldg 66, Rm 4444, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Darrel S Brodke
- Department of Orthopedics, Spencer Fox Eccles School of Medicine, University of Utah, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | | | - Khaled M Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline St Suite 5223, Baltimore, MD 21287-0882, USA
| | | | - Hassan Serhan
- Bioengineering Department, University of Toledo, 2801 W. Bancroft St, Toledo, OH 43606, USA
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12
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Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3771144. [PMID: 35966749 PMCID: PMC9374555 DOI: 10.1155/2022/3771144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study is to examine the application value of systematic nursing interventions combined with continuity of care in cases with a spinal fracture complicated with a spinal cord injury and its effect on recovery and satisfaction. Methods. We identified ninety cases with a spinal fracture complicated with a spinal cord injury who were admitted to local hospital from May 2019 to May 2021 as research subjects and assigned them into an experimental group (systematic nursing combined with continuity of care, n = 45) and a control group (conventional nursing, n = 45) according to their admission order. The level of life of all groups between intervention was evaluated with reference to the Generic Quality of Life Inventory-74 (GQOLI-74) Rating Scale. The Hospital Anxiety and Depression (HAD) scale was used to assess the emotional status of patients before and after intervention. The complication rates, nursing outcomes, nursing satisfaction, and rehabilitation outcomes of all cases were calculated. Results. The GQOLI-74 score of the experimental group was higher than that of another group (
). Lower HAD scores of experimental group were observed than that of another group (
). The experimental group obtained remarkably higher nursing effective rates and higher nursing satisfaction than another group (
). Rehabilitation outcome of the experimental group outperformed that another group (
). Conclusion. The use of systematic nursing intervention combined with continuity of care for cases with spinal fracture complicated with a spinal cord injury can enhance the nursing effect, effectively relieve cases’ psychological pressure, improve patients’ level of life and nursing satisfaction, and contribute to the maintenance of a good nurse-patient relationship, which merits clinical promotion.
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13
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Peterson MD, Berri M, Meade MA, Lin P, Kamdar N, Mahmoudi E. Disparities in Morbidity After Spinal Cord Injury Across Insurance Types in the United States. Mayo Clin Proc Innov Qual Outcomes 2022; 6:279-290. [PMID: 36532826 PMCID: PMC9754933 DOI: 10.1016/j.mayocpiqo.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To compare the prevalence and incidence of, and adjusted hazards for comorbidities among adults with traumatic spinal cord injuries (TSCIs) across insurance types (private vs governmental insurance) in the United States. PATIENTS AND METHODS Privately insured (N=9081) and Medicare (N=7645) beneficiaries with a diagnosis of TSCI were included. Prevalence and incidence estimates of common psychological, cardiometabolic, and musculoskeletal morbidities were compared at baseline and at 4-years after index diagnosis, respectively. Survival models were used to quantify hazard ratios (HRs) for outcomes, controlling for insurance type, sociodemographic characteristics, and other comorbidities. Sensitivity analyses were conducted to determine the effects of insurance and race/ethnicity. RESULTS Adults with TSCIs on Medicare had a higher prevalence of any psychological (54.7% vs 35.4%), cardiometabolic (74.7% vs 70.1%), and musculoskeletal (72.8% vs 66.3%) morbidity than privately insured adults with TSCIs. Similarly, the 4-year incidences of most psychological (eg, depression: 37.6% [Medicare] vs 24.2% [private]), cardiometabolic (eg, type 2 diabetes: 22.5% [Medicare] vs 12.9% [private], and musculoskeletal (eg, osteoarthritis: 42.1% [Medicare] vs 34.6% [private]) morbidities were considerably higher among adults with TSCIs on Medicare. Adjusted survival models found that adults with TSCIs on Medicare had a greater hazard for developing psychological (HR, 1.40; 95% CI, 1.31-1.50) and cardiometabolic (HR, 1.21; 95% CI, 1.10-1.33) morbidities compared with privately insured adults with TSCI. There was evidence of both insurance and racial disparities. CONCLUSION Adults with TSCIs on Medicare had significantly higher prevalence and risk for developing common physical and mental health comorbidities, compared with privately insured adults with TSCIs.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Maryam Berri
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Michelle A. Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor
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14
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Escalon MX, Houtrow A, Skelton F, Verduzco-Gutierrez M. Health Care Disparities Add Insult to Spinal Cord Injury. Neurol Clin Pract 2021; 11:e893-e895. [PMID: 34992973 PMCID: PMC8723932 DOI: 10.1212/cpj.0000000000001095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/09/2021] [Indexed: 11/15/2022]
Abstract
The authors describe the disparities and increased risk of traumatic spinal cord injury Black Americans face because of violence. This article should serve as a realization of these inequities and as a call to action to improve the equity of rehabilitation services in this population to improve outcomes.
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Affiliation(s)
- Miguel X Escalon
- Department of Rehabilitation and Human Performance. Icahn School of Medicine at Mount Sinai. New York (MXE), NY; Department of Physical Medicine and Rehabilitation (AH), University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovations in Quality (FS), Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; H. Ben Taub Department of Physical Medicine and Rehabilitation (FS), Baylor College of Medicine, Houston, TX; and Department of Rehabilitation Medicine (MV-G), Lozano Long School of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Amy Houtrow
- Department of Rehabilitation and Human Performance. Icahn School of Medicine at Mount Sinai. New York (MXE), NY; Department of Physical Medicine and Rehabilitation (AH), University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovations in Quality (FS), Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; H. Ben Taub Department of Physical Medicine and Rehabilitation (FS), Baylor College of Medicine, Houston, TX; and Department of Rehabilitation Medicine (MV-G), Lozano Long School of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Felicia Skelton
- Department of Rehabilitation and Human Performance. Icahn School of Medicine at Mount Sinai. New York (MXE), NY; Department of Physical Medicine and Rehabilitation (AH), University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovations in Quality (FS), Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; H. Ben Taub Department of Physical Medicine and Rehabilitation (FS), Baylor College of Medicine, Houston, TX; and Department of Rehabilitation Medicine (MV-G), Lozano Long School of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation and Human Performance. Icahn School of Medicine at Mount Sinai. New York (MXE), NY; Department of Physical Medicine and Rehabilitation (AH), University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovations in Quality (FS), Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; H. Ben Taub Department of Physical Medicine and Rehabilitation (FS), Baylor College of Medicine, Houston, TX; and Department of Rehabilitation Medicine (MV-G), Lozano Long School of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, TX
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15
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Cardinal T, Bonney PA, Strickland BA, Lechtholz-Zey E, Mendoza J, Pangal DJ, Liu J, Attenello F, Mack W, Giannotta S, Zada G. Disparities in the Surgical Treatment of Adult Spine Diseases: A Systematic Review. World Neurosurg 2021; 158:290-304.e1. [PMID: 34688939 DOI: 10.1016/j.wneu.2021.10.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our goal was to systematically review the literature on racial/ethnic, insurance, and socioeconomic disparities in adult spine surgery in the United States and analyze potential areas for improvement. METHODS We conducted a database search of literature published between January 1990 and July 2020 using PRISMA guidelines for all studies investigating a disparity in any aspect of adult spine surgery care analyzed based on race/ethnicity, insurance status/payer, or socioeconomic status (SES). RESULTS Of 2679 articles identified through database searching, 775 were identified for full-text independent review by 3 authors, from which a final list of 60 studies were analyzed. Forty-three studies analyzed disparities based on patient race/ethnicity, 32 based on insurance status, and 8 based on SES. Five studies assessed disparities in access to care, 15 examined surgical treatment, 35 investigated in-hospital outcomes, and 25 explored after-discharge outcomes. Minority patients were less likely to undergo surgery but more likely to receive surgery from a low-volume provider and experience postoperative complications. White and privately insured patients generally had shorter hospital length of stay, were more likely to undergo favorable/routine discharge, and had lower rates of in-hospital mortality. After discharge, white patients reported better outcomes than did black patients. Thirty-three studies (55%) reported no disparities within at least 1 examined metric. CONCLUSIONS This comprehensive systematic review underscores ongoing potential for health care disparities among adult patients in spinal surgery. We show a need for continued efforts to promote equity and cultural competency within neurologic surgery.
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Affiliation(s)
- Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
| | - Phillip A Bonney
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Elizabeth Lechtholz-Zey
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Jesse Mendoza
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - John Liu
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Frank Attenello
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - William Mack
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Steven Giannotta
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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16
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Balas M, Prömmel P, Nguyen L, Jack A, Lebovic G, Badhiwala JH, Da Costa L, Nathens AB, Fehlings MG, Wilson JR, Witiw CD. The Reality of Accomplishing Surgery Within 24 hours for Complete Cervical Spinal Cord Injury: Clinical Practices and Safety. J Neurotrauma 2021; 38:3011-3019. [PMID: 34382411 DOI: 10.1089/neu.2021.0177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Substantial clinical data supports an association between superior neurological outcomes and early (within 24 hours) surgical decompression for those with traumatic cervical spinal cord injury (SCI). Despite this, much discussion persists around feasibility and safety of this time threshold, particularly for those with a complete cervical SCI. This study aims to assess clinical practices and the safety profile of early surgery across a large sample of North American trauma centers. Data was derived from the Trauma Quality Improvement Program database from 2010-2016. Adult patients with a complete cervical SCI (ASIA A) who underwent surgery were included. Patients were stratified into those receiving surgery at or before 24 hours and those receiving delayed intervention. Risk-adjusted variability in surgical timing across trauma centers was investigated using mixed-effects regression. In-hospital adverse events including mortality, major complications, and immobility-related complications were compared between groups after propensity score matching. 2,862 patients from 353 North American trauma centers were included. 1,760 (61.5%) underwent surgery within 24 hours. Case-mix and hospital-level characteristics explained only 6% of the variability in surgical timing both between-centers and within-centers. No significant differences in adverse events were identified between groups. These findings suggest a relatively large proportion of patients are not receiving surgery within the recommended timeframe, despite apparent safety. Moreover, patient and hospital-level characteristics explain little of the variability in time-to-surgery. Further knowledge translation is needed to increase the proportion of patients in whom surgery is performed before the 24-hour threshold so patients might reach their greatest potential for neurologic recovery.
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Affiliation(s)
- Michael Balas
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, 27 King's College Cirle, Toronto, Ontario, Canada, M5S;
| | - Peter Prömmel
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada.,Kantonsspital St Gallen, 30883, Department of Neurosurgery, Sankt Gallen, SG, Switzerland;
| | - Laura Nguyen
- University of Ottawa, 6363, School of Medicine, Ottawa, Ontario, Canada;
| | - Andrew Jack
- University of California San Francisco, 8785, Neurological Surgery, 400 Parnassus Ave, San Francisco, California, United States, 94143;
| | - Gerald Lebovic
- St Michael's Hospital Li Ka Shing Knowledge Institute, 518773, Toronto, Ontario, Canada.,University of Toronto Institute of Health Policy Management and Evaluation, 206712, Toronto, Ontario, Canada;
| | - Jetan H Badhiwala
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada;
| | - Leodante Da Costa
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 71545, Sunnybrook Research Institute, Toronto, Ontario, Canada;
| | - Avery B Nathens
- Sunnybrook Health Sciences Centre, 71545, Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, 7938, Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada.,American College of Surgeons, 2417, Medical Director, Trauma Quality Improvement Program, Chicago, Illinois, United States;
| | - Michael G Fehlings
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada.,Toronto Western Hospital, 26625, Spine Program, Krembil Brain Institute, Toronto, Ontario, Canada;
| | - Jefferson R Wilson
- St Michael's Hospital, 10071, Division of Neurosurgery, Toronto, Ontario, Canada.,St Michael's Hospital, 10071, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.,University of Toronto, 7938, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada;
| | - Christopher D Witiw
- University of Toronto, 7938, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada.,St Michael's Hospital, 10071, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.,University of Toronto, 7938, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada;
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17
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Rahman S, McCarty JC, Gadkaree S, Semco RS, Bi WL, Dhand A, Jarman MP, Ortega G, Uribe-Leitz T, Bergmark RW. Disparities in the Geographic Distribution of Neurosurgeons in the United States: A Geospatial Analysis. World Neurosurg 2021; 151:e146-e155. [PMID: 33831612 DOI: 10.1016/j.wneu.2021.03.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Large disparities in access to neurosurgical care are known, but there are limited data on whether geographic distribution of the neurosurgery workforce potentially plays a role in these disparities. The goal of this study was to identify the geographic distribution of neurosurgeons in the United States and to study the association of the per capita workforce distribution with socioeconomic characteristics of the population. METHODS The number of practicing neurosurgeons in the United States in 2016 was obtained from the 2017-2018 American Medical Association Masterfile contained within the Area Health Resource File. The association of the number of neurosurgeons per 100,000 population with socioeconomic characteristics was assessed through linear regression analysis at Hospital Referral Region (HRR) level. RESULTS The median number of neurosurgeons per capita across all HRRs was 1.47 neurosurgeons per 100,000 population (interquartile range, 1.02-2.27). Bivariable analysis showed that greater supply of neurosurgeons was positively associated with regional levels of college education, median income, and median age. The number of neurosurgeons per capita at the HRR level was negatively associated with unemployment, poverty, and percent uninsured. CONCLUSIONS Regions characterized by low socioeconomic status have fewer neurosurgeons per capita in the United States. Low income, low number of college graduates, and high unemployment rate are associated with fewer numbers of neurosurgeons per capita. Further research is needed to determine if these geographic workforce disparities contribute to poor access to quality neurosurgical care.
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Affiliation(s)
- Sarah Rahman
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Justin C McCarty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shekhar Gadkaree
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert S Semco
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tarsicio Uribe-Leitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
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Odonkor CA, Esparza R, Flores LE, Verduzco-Gutierrez M, Escalon MX, Solinsky R, Silver JK. Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review. PM R 2020; 13:180-203. [PMID: 33090686 DOI: 10.1002/pmrj.12509] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023]
Abstract
Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.
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Affiliation(s)
- Charles A Odonkor
- Department of Orthopaedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Rachel Esparza
- Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Miguel X Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Massachusetts General Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Factors Associated With In-Hospital Outcomes of Traumatic Spinal Cord Injury: 10-year Analysis of the US National Inpatient Sample. J Am Acad Orthop Surg 2020; 28:707-716. [PMID: 32833389 DOI: 10.5435/jaaos-d-18-00728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (SCI) is a life-altering event. Motor vehicle accidents and falls are common causes of traumatic SCI, and SCI outcomes may be affected by patients' ages and injury sites. This study aimed to investigate the factors associated with unfavorable in-hospital outcomes, focusing on the impact of patients' ages and SCI lesion sites. METHODS Data of 25,988 patients hospitalized with traumatic SCI in the US National Inpatient Sample (NIS) database from 2005 to 2014 were extracted and analyzed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with SCI outcomes, including in-hospital deaths, adverse discharge, and prolonged hospital stays. RESULTS Multivariate analysis revealed that the oldest ages (>65 years) were significantly associated with increased in-hospital mortality compared with the youngest ages at all lesion sites (cervical, odds ratio [OR]: 5.474, 95% confidence interval [CI]: 4.465 to 6.709; thoracic, OR: 5.940, 95% CI: 3.881 to 9.091; and lumbosacral, OR: 6.254, 95% CI: 2.920 to 13.394). Older ages were also significantly associated with increased adverse outcomes at all sites (cervical, OR: 2.460, 95% CI: 2.180 to 2.777; thoracic, OR: 2.347, 95% CI: 1.900 to 2.900; and lumbosacral, OR: 2.743, 95% CI: 2.133 to 3.527). Intermediate ages (35 to 64) were also significantly associated with increased in-hospital death and adverse discharge at cervical and thoracic SCIs, but not at lumbosacral sites. DISCUSSION For hospitalized patients with traumatic SCI, older age independently predicts worse in-hospital outcomes, with greatest effects seen in patients aged 65 years and older. Study findings suggest that extra vigilance and targeted management strategies are warranted in managing SCI patients aged 65 years and older during hospitalization.
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Commentary: Do you live in a distressed community? How do you know? What does this mean? What are the risks? How do you get help? J Thorac Cardiovasc Surg 2019; 160:434-436. [PMID: 31383560 DOI: 10.1016/j.jtcvs.2019.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
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