Prognostic Factors of High Healthcare Utilization Costs Among People With Spinal Disorders Using a Spine Registry Linked to Public Healthcare Data

BACKGROUND: Spinal disorders are associated with substantial healthcare costs, but prognostic factors associated with high spine-related healthcare expenditures remain insufficiently understood. Therefore, this study aimed to identify prognostic factors associated with spine-related healthcare costs among patients with spinal disorders. METHODS: A prognostic factor study using data from the Norwegian Neck and Back Registry was conducted. Thirty-four potential prognostic factors were considered. Spine-related healthcare costs were analyzed as a continuous outcome. Continuous predictors were modelled using restricted cubic splines to account for potential non-linear associations. Univariable and multivariable adjusted models were fitted, with priori defined covariate adjustments. RESULTS: The study included 7877 patients with spinal pain. In adjusted models, healthcare region (patients from the Mid-Norway, West and Southeast regions incurred 69.1%, 44.5% and 29.6% higher costs, respectively, compared with those in the North), disability (90th vs. 10th percentile: +29.2%; CI +11.9% to +49.2%), pain during activity (90th vs. 10th percentile: +23.4%; CI +7.6% to +41.6%), health-related quality of life (90th vs. 10th percentile: -21.3%; CI -31.1% to -10.0%), job satisfaction (90th vs. 10th percentile: +14.7%; CI +2.3% to +28.7%), and opioid use (+15.3%; CI +5.7% to +26.2%) were associated with healthcare costs. CONCLUSIONS: This set of identified prognostic factors may be useful for characterizing patient subgroups, developing prognostic models to identify individuals at risk of high healthcare expenditures, and informing strategies to improve the efficiency and equity of healthcare resource allocation. SIGNIFICANCE: This study identifies clinical and societal determinants of health associated with high spine-related healthcare costs, highlighting how these factors jointly drive resource use. These findings help clarify mechanisms underlying cost variation and support the future development of prognostic tools and targeted strategies to improve efficiency and equity in spine care.