1017 Socioeconomic and Racial Disparities in Access to Care in Patients With Cervical Spondylotic Myelopathy: A Quality Outcomes Database Study

INTRODUCTION: Access to surgical subspeciality care is difficult to measure. Cervical spondylotic myelopathy (CSM) is a disease with high rate of progression without surgical intervention and, thus, longer symptom duration and initial symptom severity are surrogates for access to surgical care. The prospective Quality Outcomes Database (QOD) may provide insight into access to care for patients seeking surgery for CSM. METHODS: 1141 patients in the QOD with CSM underwent surgery. Access to care was measured by symptom duration (primary outcome) and baseline patient reported outcomes (PROs) including Neck Disability Index (NDI), Visual Analogue Scale-Neck Pain (VAS-NP), Visual Analogue Scale-Arm Pain (VAS-AP) and modified Japanese Orthopedic Association score (mJOA) (secondary outcomes). Multivariate logistic regression models including gender, race/ethnicity, insurance and socioeconomic status (SES) were created to predict symptom duration and baseline PROs. RESULTS: On multivariate modeling, prolonged symptom duration (>12m) was associated with Medicaid (OR 1.81, CI 1.08-3.08) and workers compensation (OR 0.39 CI 0.15-0.95). Similarly, modeling demonstrated an association between Medicaid and worse baseline NDI (β 0.37 CI 0.16-0.59), neck pain (β 0.23 CI 0.01-0.46) and mJOA (β -0.24 CI -0.47 to -0.01). Additionally, African-Americans (β 0.28 CI 0.13-0.43) were more likely to have a worse baseline NDI. Other variables associated with worse baseline PROs were SES for NDI (β -0.10 CI -0.15 to -0.04), VAS-NP (β -0.09 CI -0.14 to -0.03), VAS-AP (β -0.1 CI -0.15 to -0.04) and mJOA (β 0.08 CI 0.02-0.14) and educational level for NDI (β -0.18 CI -0.29 to -0.07), VAS-NP (β -0.26 CI -0.38 to -0.15), and VAS-AP (β -0.17 CI -0.28 to -0.05). CONCLUSIONS: For patients with CSM, disparities exist in access to care. Medicaid patients particularly suffer from prolonged symptom duration and worse baseline disease status before access to surgical care.