Racial and Health Insurance Status Disparities in the Use of Percutaneous Vertebral Augmentation and Healthcare Utilization for Osteoporotic Vertebral Fractures: A Retrospective Observational Analysis
Author(s)
Shuo Zhang, MSc1, Nan Peng, Ph.D.2, Mengyao Xue, MSc1, Dongning Yao, Ph.D.1, Dr. Shitong Xie, PhD3.
1Nanjing Medical University, Nanjing, China, 2China Pharmaceutical University, Nanjing, China, 3Tianjin University, Tianjin, China.
1Nanjing Medical University, Nanjing, China, 2China Pharmaceutical University, Nanjing, China, 3Tianjin University, Tianjin, China.
OBJECTIVES: This study aims to investigate racial and insurance disparities in the utilization of percutaneous vertebral augmentation (PVA) and postoperative healthcare utilization among patients with osteoporotic vertebral compression fractures (OVCF).
METHODS: A retrospective study using 2016-2021 U.S. National Inpatient Sample data to identify older adults with OVCF were conducted. The primary outcome was PVA utilization, while secondary outcomes included discharge disposition, length of stay (LOS), and inpatient costs. Chi-square tests and multivariate logistic regression were used.
RESULTS: Among 28,803 patients with OVCF, of whom 7,545 (26.2%) underwent PVA, 87.3% were White, 3.0% were Black, 6.0% were Hispanic, and 3.7% were Asian/Pacific Islander. Black patients (OR=0.67, 95% CI: 0.62-0.73, P<0.001), Hispanics (OR=0.91, 95% CI: 0.86-0.96, P<0.001), and Asian/Pacific Islander (OR=0.92, 95% CI: 0.86-0.99, P=0.02) had significantly lower odds of PVA compared to Whites. Medicaid (OR=0.81, 95% CI: 0.75-0.87, P<0.001), private insurance (OR=0.86, 95% CI: 0.82-0.91, P<0.001), and self-pay patients (OR=0.77, 95% CI: 0.65-0.90, P=0.001) had significantly lower odds of PVA compared to Medicare. Among patients undergoing PVA, black patients had significantly higher odds of high LOS (OR=1.54, 95% CI: 1.33-1.78, P<0.001) and high total cost (OR=1.24, 95% CI: 1.06-1.45, P=0.007) compared with Whites. Patients with Medicaid had significantly higher odds of high LOS (OR=1.28, 95% CI: 1.11-1.46, P<0.001) and high total cost (OR=1.20, 95% CI: 1.04-1.39, P=0.01) compared with those with Medicare. Patients with private insurance had lower odds of high total cost (OR=0.87, 95% CI: 0.79-0.96, P=0.008) but had higher odds of routine disposition (OR=1.31, 95% CI: 1.20-1.44, P<0.001) compared with patients with Medicare.
CONCLUSIONS: Racial and health insurance disparities exist with the utilization of percutaneous vertebral augmentation and healthcare utilization in patients with osteoporotic vertebral compression fractures.
METHODS: A retrospective study using 2016-2021 U.S. National Inpatient Sample data to identify older adults with OVCF were conducted. The primary outcome was PVA utilization, while secondary outcomes included discharge disposition, length of stay (LOS), and inpatient costs. Chi-square tests and multivariate logistic regression were used.
RESULTS: Among 28,803 patients with OVCF, of whom 7,545 (26.2%) underwent PVA, 87.3% were White, 3.0% were Black, 6.0% were Hispanic, and 3.7% were Asian/Pacific Islander. Black patients (OR=0.67, 95% CI: 0.62-0.73, P<0.001), Hispanics (OR=0.91, 95% CI: 0.86-0.96, P<0.001), and Asian/Pacific Islander (OR=0.92, 95% CI: 0.86-0.99, P=0.02) had significantly lower odds of PVA compared to Whites. Medicaid (OR=0.81, 95% CI: 0.75-0.87, P<0.001), private insurance (OR=0.86, 95% CI: 0.82-0.91, P<0.001), and self-pay patients (OR=0.77, 95% CI: 0.65-0.90, P=0.001) had significantly lower odds of PVA compared to Medicare. Among patients undergoing PVA, black patients had significantly higher odds of high LOS (OR=1.54, 95% CI: 1.33-1.78, P<0.001) and high total cost (OR=1.24, 95% CI: 1.06-1.45, P=0.007) compared with Whites. Patients with Medicaid had significantly higher odds of high LOS (OR=1.28, 95% CI: 1.11-1.46, P<0.001) and high total cost (OR=1.20, 95% CI: 1.04-1.39, P=0.01) compared with those with Medicare. Patients with private insurance had lower odds of high total cost (OR=0.87, 95% CI: 0.79-0.96, P=0.008) but had higher odds of routine disposition (OR=1.31, 95% CI: 1.20-1.44, P<0.001) compared with patients with Medicare.
CONCLUSIONS: Racial and health insurance disparities exist with the utilization of percutaneous vertebral augmentation and healthcare utilization in patients with osteoporotic vertebral compression fractures.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO136
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Geriatrics, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery