Spinal Conditions

Racial disparities in the prevalence of spinal conditions have sparsely been discussed in the literature. Most spinal deformities, including scoliosis, have the higher rates of diagnosis in Caucasians (BMUS). A 2011 retrospective study of patients over 40 years old revealed a prevalence of almost twice the rate of scoliosis in whites compared to African-Americans (AA).1 Specific to adolescent idiopathic scoliosis (AIS), African-American patients had higher curvatures at presentation compared with whites and Hispanics. Therefore, they were more likely to have surgery as their initial treatment.2 For this reason, AA patients may need to present at an earlier age for screening. There is a general belief that genetics play a role in progression of AIS; however, it is unknown which genetic factors or whether race is involved.

Lumbar radiculopathy is a spinal nerve root condition caused by nerve compression, inflammation, or injury in the lumbar spine. In a database study of a young, military population, lumbar radiculopathy was found to be more common among white patients.3 Lumbar spinal stenosis, a narrowing of the spinal canal resulting in nerve compression, is another major cause of low back pain and nerve symptom. Overall, hospitalizations for this condition have been reported to be much more common in whites. Blacks and Hispanics have lower rates of surgical hospitalization for lumbar spinal stenosis than did whites.4 Cultural barriers and attitude toward surgery may be responsible for this difference. In patients undergoing surgery for lumbar stenosis, blacks have higher complication rates, longer hospital stays, less likelihood of discharge home, and short preoperative and postoperative follow-up.5^,6 African-American patients also accrue higher hospital-related costs and are prescribed fewer medications.5 Cervical spine surgeries have also been analyzed. African-American patients have higher rates of in-hospital complications and mortality than other ethnicities.7 Much of this difference was likely due to socioeconomic status, insurance status, and access issues.

Ankylosing spondylitis (AS) is an inflammatory arthritis that primarily affects the spine. AS is highly associated with the HLA B27 gene. AS is three times more common in whites than in blacks.8 This is mostly due to the lower prevalence of HLA-B27 in individuals of African descent. A prospective study by Jamalyaria et al compared the disease severity of AS in different ethnic groups. They determined that African-Americans, and Hispanics to a lesser degree, have greater functional impairment, higher disease activity, and greater radiographic severity compared to whites.9 The reason for this could not be determine; however, access to care and genetics are potential factors.

There is conflicting data related to racial differences in back pain. Hootman and Strine reported on 3-month prevalence rates of neck and back pain and found a higher prevalence in whites than other ethnic groups.10 Knox et al analyzed the rates of low back pain in military service members resulting in a visit to a health care provider and reported the highest incidence rates among African-Americans.11 The reason behind the variability is unknown; however, there is believed to be a genetic component. Importantly, a survey study found no significant differences in care-seeking behavior between racial groups for acute or chronic low back pain.12

Self-Reported Back Pain

Non-Hispanic white persons report experiencing neck/cervical and lumbar/low back pain at slightly higher rates in the previous year than members of other racial/ethnic groups. However, back pain with radiating leg pain was reported at similar rates among all racial/ethnic groups except for other/mixed non-Hispanic persons, who reported a lower rate.

In 2015, 36.4% of non-Hispanic white persons reported back pain, compared to 31.0% of non-Hispanic blacks, 30.3% of persons of Hispanic ethnicity, and 26.4% of non-Hispanic others. Low back/lumbar pain was mentioned about twice as often as neck/cervical pain. Respondents are asked if they have radiating leg pain only if the identify suffering from low back pain. Approximately one-third of persons with low back pain also reported radiating leg pain, with non-Hispanic black persons highest (39%) and non-Hispanic other/mixed persons lowest (34%). (Reference Table 7D.2 PDF [1] CSV [2])

bmus_e4_g7d.1.1.png [3]

[4]

Healthcare Visits

Non-Hispanic whites (18.4 per 100 persons) were slightly more likely to seek healthcare for treatment of low back/lumbar pain in 2013 than non-Hispanic blacks (17.1/100) and Hispanics (14.2/100). However, non-Hispanic others/mixed race were much less likely to seek healthcare for back pain (7.3/100). Rates for non-Hispanic whites (6.2/100) and non-Hispanic others (6.0) were similar for healthcare visits for neck/cervical pain, but lower for non-Hispanic blacks (4.5) and Hispanics (3.0). (Reference Table 7D.2 PDF [1] CSV [2])

bmus_e4_g7d.1.2.png [5]

[6]

Back Pain Burden

Non-Hispanic black persons report the highest number of bed days in the previous year due to back pain (8.7 days on average), while those of Hispanic ethnicity lost, on average, the most work days (14.1 days).  (Reference Table 7D.2 PDF [1] CSV [2])

bmus_e4_g7d.1.3.png [7]

[8]

bmus_e4_g7d.1.4.png [9]

[10]

• 1. Kebaish KM, MD; Neubauer PR, Voros GD, et al. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine 2011;36(9):731-736.
• 2. Zavatsky JM. Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status. Spine J 2015;15(5):939-943.
• 3. Schoenfeld AJ, Laughlin M, Bader JO, Bono CM. Characterization of the incidence and risk factors for the development of lumbar radiculopathy. J Spinal Disord Tech 2012;25(3):163-167.
• 4. Skolasky RL, Maggard AM, Thorpe RJ Jr, et al. United States hospital admissions for lumbar spinal stenosis: racial and ethnic differences, 2000 through 2009. Spine (Phila PA 1976) 2013;38(26):2272-2278.
• 5. a. b. Lad SP, Bagley JH, Kenney KT, et al. Racial disparities in outcomes of spinal surgery for lumbar stenosis. Spine (Phila PA 1976) 2013;38(11):927-935.
• 6. Drazin D, Shweikeh F, Lagman C, Ugiliweneza B, Boakye M. Racial disparities in elderly patients receiving lumbar spinal stenosis surgery. Global Spine J 2017;7(2):162-169.
• 7. Krause JS, Broderick LE, Saladin LK, Broyles J. Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income. J Spinal Cord Med 2006;29(1):17-25.
• 8. Khan MA. Race-related differences in HLA association with ankylosing spondylitis and Reiter's disease in American blacks and whites. J Natl Med Assoc 1978;70(1):41-42.
• 9. Jamalyaria F, Ward MM, Assassi S, et al. Ethnicity and disease severity in ankylosing spondylitis: a cross-sectional analysis of three ethnic groups. Clin Rheumatol 2017;36(10):2359-2364.
• 10. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum 2007;57(4):656-665.
• 11. Knox JB, Orchowski JR, Owens B. Racial differences in the incidence of acute low back pain in United States military service members. Spine (Phila PA 1976) 2012;37(19):1688-1692.
• 12. Carey TS, Freburger JK, Holmes GM, et al. Race, care seeking, and utilization for chronic back and neck pain: population perspectives. J Pain 2009;11(4):343-350.