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Disparities between diverse population groups in effective healthcare treatments and outcomes may place certain groups at higher risk than others. In spite of development and advances in the healthcare system, prior research has proved the presence of disparities in the use of health services based on race (1, 2). Credible evidence has shown that race, ethnicity, and linguistics play a role in how symptoms are presented and how they contribute to which symptoms are significant (3, 4). Additionally, it has been shown that racial and ethnic minorities tend to receive lower quality of care, and experience greater morbidity and mortality from various chronic diseases than non-minorities (5, 6).
Health care institutions are challenged to implement protocols to collect this data for identifying the contributing factors in care. When such data is underdeveloped and incomplete, it may lead to inefficient and inaccurate apprehension of aspects that affect care. For instance, language barriers should not serve as a valid excuse for quality of care of racial and ethnic minorities to be compromised. Specific to the spinal care community, studies have shown racial differences can have an impact on timings and outcomes, post-operatively. A presentation at North American Spine Society’s annual meeting in 2011 investigated records of 2,071 patients with spinal metastases who underwent spinal decompression with or without fusion. They found that racial and ethnic minorities were significantly less likely to receive early intervention. Compared to Caucasians, data also showed that there were significant increases of mortality rate in African Americans and complication rate in Hispanics (7). Another study showed that Black patients were 8-14% more likely than Caucasians to experience spine surgery-specific complications and general postoperative complications, respectively, with increased odds of 30-day and 90-day re-admissions; therefore, Black patients required longer durations of hospital stay following lumbar spinal fusion surgery (8).
If no firm conclusions are currently drawn in regard to the effect of race or ethnicity on outcomes after spine surgery, why is this data incomplete?
A survey concluded that 75% of health care providers (HCPs) believed it was unnecessary and potentially disturbing to patients to collect race and ethnicity-based data (6). Some believe such data does not enhance health care for marginalized groups, others believe that it is unimportant to monitor such metrics, and some HCPs possess a misconception that it is illegal to collect race and ethnicity information from patients. Thus, the lack of understanding on how to approach patients to collect this information plays a major factor in data collection barriers. Baker et al. (2005) conducted a study on patients’ attitudes toward HCPs collecting such information, and concluded that 80% of patients agreed that HCPs should collect this information. However, some patients reported feeling uncomfortable by this collection (9, 10). Understandably, some patients may feel awkward when asked questions about their race or ethnicity, but perhaps with reassurance as to why they are being asked this information (i.e. to monitor treatment quality), patients’ stances toward the study’s questions may change. In principle, such studies may imply attempts to improve and monitor any health care disparities in institutions.
If health care systems commit to systematically collecting race, ethnicity, and language data from patients, this could drive and enhance health care processes and in monitoring outcomes for different population groups. Furthermore, health research provides a greater opportunity to move beyond interview questions and obtain nuanced information through self-report.
The accuracy of data on race and ethnicity is also useful for selecting other factors that may be contributing to discrepancies in health care between amidst different racial and ethnic groups (i.e. socioeconomic barriers) and to ensure adequacy and accessibility of services (i.e. interpreter, cultural competency, and accessible information).
There is a dire need for increasingly robust investigations in regard to spine surgical outcomes among racial and ethnic minority groups. The lack of this information leads to a dearth of knowledge about which members of our society are at the most risk. The pragmatism of medicine without social science (i.e. biological concept of race) is an obstacle in the management of effective and efficient intervention strategies in the healthcare system. The significance of this collection is clear and well supported by empirical evidence; thus, healthcare institutions appear to fall behind on the implications for the nature-nurture debate. To effectively manage health care outcomes of patients in a holistic manner, race and ethnicity data collection is a necessary component in broadening the knowledge base and in measuring disparities on how these variables may have an effect on spine surgery and other health outcomes.
References:
1. Bruce Ettinger, Stephen Sidney, Steven R. Cummings, Cesar Libanati, Daniel D. Bikle, Irene S. Tekawa, Kimberly Tolan, Peter Steiger, Racial Differences in Bone Density between Young Adult Black and White Subjects Persist after Adjustment for Anthropometric, Lifestyle, and Biochemical Differences, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 2, 1 February 1997, Pages 429–434, https://doi.org/10.1210/jcem.82.2.3732
2. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57:108–45.
3. Smedley BD BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.
4. Bartlett E E, Grayson M, Barker R, Levine D M, Godlen A, Libber S. The Effects of Physician Communication Skills on Patient Satisfaction, Recall, and Adherence. Journal of Chronic Diseases. 1984;37:755–64.
5. Timmins C L. The Impact of Language Barriers on Health Care of Latinos in the United States: A Review of the Literature and Guidelines for Practice. Journal of Midwifery and Women's Health. 2002;47(2):80–96.
6. Egede, L.E. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med 21, 667 (2006). https://doi.org/10.1111/j.1525-1497.2006.0512.
7. Management of musculoskeletal pain in a compensable ... (n.d.). Retrieved from https://www.researchgate.net/publication/310739464_Management_of_musculoskeletal_pain_in_a_compensable_environment_Implementation_of_helpful_and_unhelpful_Models_of_Care_in_supporting_recovery_and_return_to_work
8. Aladdin, D. E. H., Tangel, V., Lui, B., Pryor, K. O., Witkin, L. R., & White, R. S. (2020). Black Race as a Social Determinant of Health and Outcomes After Lumbar Spinal Fusion Surgery. SPINE, 45(10), 701–711. https://doi.org/10.1097/brs.0000000000003367
9. Hasnain-Wynia, R. and Baker, D., 2006. Obtaining Data on Patient Race, Ethnicity, and Primary Language in Health Care Organizations: Current Challenges and Proposed Solutions. Health Services Research, 0(0), p.060720074824036
10. Baker, D.W., Cameron, K.A., Feinglass, J. et al. Patients’ attitudes toward health care providers collecting information about their race and ethnicity. J GEN INTERN MED 20, 895–900 (2005). https://doi.org/10.1111/j.1525-1497.2005.0195.x
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