Social inequality in healthcare: profiling high and low healthcare users in primary care among Danish patients with spinal pain

Abstract Aim This study aimed to investigate the distribution of all-cause primary healthcare use (general practitioners [GPs], physiotherapists, chiropractors) and identify patient characteristics related to high use in the year following an assessment at a hospital spine clinic among patients with spinal pain. Subject and methods We linked self-reported data from 48,616 adult patients assessed at a Danish hospital spine clinic between 2016 and 2021 with national registry data. We investigated the distribution of consultations with GPs and physiotherapists/chiropractors in the year following the assessment using Lorenz plots. Multivariable logistic regression was used to examine associations between sociodemographic and clinical patient characteristics and high (versus low) healthcare utilization. All analyses were conducted separately for consultations with GPs and physiotherapists/chiropractors. Results Overall, 25% of patients accounted for 58% of GP consultations and 92% of consultations with physiotherapists/chiropractors. Being female or retired, having a medium income (versus low), being on sick leave, and having higher spinal pain and disability were all associated with high use of GPs and physiotherapists/chiropractors. Higher education, higher income, and having employer-paid healthcare insurance were negatively associated with high GP use but were positively related to high use of physiotherapy/chiropractic care. Conclusions One-fourth of patients with spinal pain accounted for the majority of primary care consultations following assessment in a Danish hospital spine clinic. Higher socioeconomic status was negatively associated with the number of GP consultations under public healthcare in Denmark. In contrast, it was positively associated with physiotherapy or chiropractic care requiring out-of-pocket payment. These results indicate social inequality in healthcare utilization among individuals with spinal pain in Denmark.