Racial and Ethnic Disparities in Degenerative Lumbar Disc Disease: A Population-Based Study Using the All of Us Research Program.

Abstract

BackgroundDegenerative lumbar disc disease (DLDD) can contribute to substantial low back pain and radicular leg pain. Emerging evidence suggests that racial and ethnic disparities in DLDD care could impact clinical outcomes, yet these trends remain largely unexplored. This study investigates differences in health literacy, access to care, and healthcare utilization among patients with DLDD using the All of Us (AoU) Research Program.MethodsAdults diagnosed with DLDD were identified from the AoU database using ICD-9 and ICD-10 diagnostic codes. Participants were stratified by race and ethnicity into White, Black, Hispanic, and Other. Demographics, socioeconomic status, health literacy (BRIEF score), healthcare access, and treatment utilization across racial and ethnic groups were compared across cohorts using chi-square analyses. Multivariate logistic regressions evaluated these outcomes while adjusting for demographic and socioeconomic status.ResultsIn total, 30,775 participants with DLDD were identified. Most participants were 65+ years (62.8%) and female (65.3%), with 74.0% self-identifying as White, 10.7% as Black, 8.1% as Hispanic, and 7.2% as Other. Compared to Whites, Black and Hispanic participants were significantly more likely to report limited health literacy (White = 15.3%, Black = 22.2%, Hispanic = 28.1%, Other = 21.3%, <i>P</i> < 0.001). In addition, they were more likely to be denied insurance coverage (9.7%, 10.5%, 14.5%, 13.8%) and report difficulty affording care, including prescription medications (11.5%, 20.9%, 19.0%, 18.9%) and follow-up visits (6.2%, 10.0%, 10.7%, 9.3%) (all <i>P</i> < 0.001). Finally, Black participants, in particular, were more likely to receive nonoperative treatments such as physical therapy (25.7%, 28.2%, 23.1%, 25.9%), steroid injections (14.4%, 16.7%, 12.8%, 12.4%), and opioids (49.1%, 53.4%, 42.5%, 48.3%) compared to White participants (all <i>P</i> < 0.001). Many of these disparities persisted in multivariate models after adjusting for demographic and socioeconomic covariates.ConclusionDisparities in DLDD are multifactorial, reflecting the intersection of age, sex, race/ethnicity, comorbidities, and social determinants of health. Despite most participants being Medicare-eligible, minority groups continued to report access and affordability barriers, suggesting the role of underinsurance and coverage gaps. These findings underscore the need for targeted interventions to improve access, promote education, and ensure equitable treatment of DLDD across minority populations.