Inequities in time-to-follow-up care and administrative action after low back pain diagnosis in active duty service members

As healthcare systems adopt data-driven methods to determine resource allocation for treating low back pain (LBP), it is critical to evaluate equity in time-to-follow-up care after an index visit and long-term occupational outcomes. This retrospective observational study included medical records of 525,252 active duty US service members who received an LBP index diagnosis from June 2016 to February 2022. Poisson generalized additive models evaluated time-to-LBP follow-up visit (primary outcome) and administrative action receipt (eg, disability evaluation; secondary outcome). Service members assigned female in the medical record compared to service members assigned male had lower cumulative hazards of follow-up visit at 1-week, but higher hazards by 4 weeks. Asian and Pacific Islander, Black, and Latino service members compared to white service members had lower cumulative hazards of follow-up visit during the acute/subacute period (up to 7, 19, 31, weeks, respectively), then higher cumulative hazards. Service members whose race and ethnicity was recorded as Other had lower hazards across time. Service members assigned female in the medical record compared to service members assigned male had lower cumulative hazards of administrative action receipt, as did Asian and Pacific Islander, Black, and Latino service members and service members whose race and ethnicity was recorded as Other compared to white service members. Overall, inequities in LBP follow-up visit timing warrant system-level programming to mitigate healthcare barriers acutely and subacutely after an LBP index visit, as well as system-level evaluation of pathways to administration action receipt.