Race Differences in Diagnosis and Surgery for Occupational Low Back Injuries

[Alastair]

Race Differences in Diagnosis and Surgery for Occupational Low Back Injuries
Posted 06/02/2006

John T. Chibnall, PhD; Raymond C. Tait, PhD; Elena M. Andresen, PhD; Nortin M. Hadler, MD

Abstract and Introduction
Abstract
Study Design: Population-based telephone survey in Missouri.
Objective: To examine the unique contribution of race to diagnosis and surgery rates in workers' compensation claimants.
Summary of Background Data: Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers' compensation case management outcomes (treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries.
Participants and Methods: African American (n = 580) and white (n = 892) workers' compensation claimants with single-incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis (herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated.
Results: Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery.
Conclusions: Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers' compensation medical expenditures, disability ratings, and settlement awards.

Introduction
Considerable evidence documents racial and socioeconomic differences in health care access and delivery in the United States,[1] affecting both acute and chronic pain conditions.[2-8] Regarding occupational low back injuries, our recent study of a large cohort of workers' compensation claimants in Missouri (Disparities in Occupational Lumbar Injury Outcomes Research [DOLOR]) documented substantially lower treatment expenditures, disability ratings, and settlement awards for African Americans, relative to whites (controlling for multiple covariates).[9] However, potential mediators of these differences have yet to be explored.

Previous research has indicated that diagnosis and treatment type are potential mediators.[7,9] Claimants for whom nonspecific diagnoses are made for low back pain (e.g., regional low back pain) and claimants who do not undergo surgical treatment receive lower treatment expenditures, disability ratings, and settlement awards, relative to claimants with specific diagnoses (e.g., herniated disc) and surgery. Thus, we know from 2 cohorts of workers' compensation claimants that diagnosis/surgery[7,9] and race[9] uniquely predict case management outcomes. If race also predicts diagnosis and rates of surgery, then race disparities in case management are, in part, mediated by differences between African Americans and whites regarding diagnosis and sur
More on this link

http://www.medscape.com/viewarticle/533004?src=mp

[Harrison]

An interesting follow-up to this is found on the OrthoSuperSite:

Cultural and gender differences begin to impact new knee prosthesis designs

FDA clears Zimmer’s gender-specific knee as interest in cultural-specific total joints grows.

http://www.orthosupersite.com/defaul...view&rid=17312
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My bet is that in the next 1-2 years, you'll see more information from the artificial disc companies on this kind of thing. One example as to why is the gender differences in bone density -- but time will tell.