Racial and Ethnic Disparities in the Inpatient Management of Primary Spinal Cord Tumors.

Abstract

Racial disparities, such as differential treatment and provider bias, negatively affect quality of life for minority patients. However, literature evaluating racial/ethnic differences in the treatment of primary spinal cord tumors (SCTs), a rare condition relying primarily on neurosurgical care, is lacking. We conducted a retrospective cohort study of all primary SCT discharges from 2012 to 2016 within the National Inpatient Sample, a 20% all-payer database from hospitals across 47 U.S. states. Relative risks (RRs) for the association of race with mortality, receipt of surgery, and disposition, as well as length of stay and hospital charges, were calculated. A total of 1296 discharges met inclusion and exclusion criteria. Inpatient mortality was similar across all racial/ethnic groups. Compared with white patients, African Americans were less likely to receive surgical intervention for the same diagnosis (RR, 0.80; 95% confidence interval [CI], 0.70-0.93) and to be discharged home (RR, 0.68; 95% CI, 0.50-0.91) as opposed to a skilled nursing or intermediate-care facility (RR, 1.55; 95% CI, 1.06-2.27). Hispanic patients remained in the hospital 2-3 days longer (6.12 ± 5.86 vs. 8.61 ± 10.97; P = 0.028), resulting in higher hospital charges (U.S. $111,357.02 ± $99,468.44 vs. $163,416.30 ± $228,420.60; P = 0.022). African Americans were less likely to receive surgical intervention for treatment of primary SCTs compared with whites. Hispanic patients faced longer hospital stays. These disparities may be attributed to compromised access, provider attitudes and biases, communication barriers, or historical distrust in the medical community: issues that health care reform should address.