Intersection of race and ethnicity with perceptions of health status and literacy in adult patients with spinal deformity: insights from the all of us research program.

Abstract

This study evaluated racial disparities in health perception, health literacy, and barriers to care in patients with adult spinal deformity (ASD). We conducted a cross-sectional study using the National Institutes of Health All of Us survey database. Adult patients with spinal deformities were identified using ICD-9/10 codes and categorized by race: non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic or Latino (HL). Survey responses regarding demographics, socioeconomic status, health status, health perceptions, health literacy, and barriers to healthcare were compared between groups. In our cohort of 9271 patients, 69.7% were NHW, 15.7% were NHB, and 14.6% were HL. NHW patients reported the highest education, annual income, employment, married status, and home ownership (p < 0.001). HL patients reported both the highest and lowest fatigue (p < 0.001). NHB patients reported more pain (p < 0.001), while the HL cohort reported more emotional problems (p < 0.001). NHW patients accomplished more everyday activities (p < 0.001). HL patients had the worst self-perceptions of health (p < 0.001) and the least health literacy (p < 0.001). NHW patients were the least worried about paying for care (p < 0.001); however, they more often reported delaying prescriptions to save money (p = 0.041) and not being able to afford dental or specialist care (p < 0.001), deductibles (p = 0.003), or copays (p < 0.001). NHB patients experienced more transportation issues (p < 0.001), and HL patients experienced more issues with childcare or getting time off work (p < 0.001). Our study points to racial disparities in self-perception of health, literacy, and barriers to care among ASD patients.