United States Hospital Admissions for Lumbar Spinal Stenosis: Racial and Ethnic Differences, 2000 Through 2009

STUDY DESIGN.Retrospective analysis of Nationwide Inpatient Sample and US Census data. OBJECTIVE.To (1) document national trends in surgical hospitalizations with the primary diagnosis of lumbar spinal stenosis from 2000 through 2009; and (2) evaluate how those trends relate to race and ethnicity. SUMMARY OF BACKGROUND DATA.In the United States, the rate of lumbar spinal stenosis surgery is increasing, and understanding how changing demographic trends impact hospitalization rates for this surgery is important. METHODS.Multivariable regression models were used to determine associations between race and ethnicity and the rates of surgical hospitalization for lumbar spinal stenosis. All models were adjusted for age, sex, insurance, income status, geographical location, and comorbidities. RESULTS.From 2000 through 2009, the overall surgical hospitalization rate increased by 30%. Surgical hospitalization rates for lumbar spinal stenosis in the United States varied substantially across racial and ethnic groups. In 2009, white, non-Hispanics had the highest rate (1.074 per 1000) compared with black, non-Hispanics (0.558 per 1000; P< 0.001), and Hispanics (0.339 per 1000; P< 0.001). The relative differences persisted across time. CONCLUSION.There were substantial differences in rates of surgical hospitalization among individuals of different racial and ethnic groups. Possible causes were (1) differences in clinical decision making among spine care providers with regard to offering surgical care to minority populations; (2) differences in access to care because of financial, educational, or geographical barriers; and (3) differences in attitudes toward surgical care among those of different racial and ethnic groups.Level of Evidence3