Racial and Insurance Disparities in Percutaneous Vertebral Augmentation and Postoperative Healthcare Utilization for Osteoporotic Vertebral Fractures: A National Inpatient Sample Analysis

Abstract While studies demonstrated racial and health insurance status disparities in percutaneous vertebral augmentation (PVA) utilization for osteoporotic vertebral compression fractures (OVCF), postoperative resource use disparities remain unclear. Using 2016–2021 National Inpatient Sample, we conducted a retrospective study analyzing racial and insurance-related differences in PVA utilization and postoperative care among OVCF patients aged ≥ 50 years, excluding those with cancer. Multivariate logistic regression analysis was used to compare the utilization of PVA, kyphoplasty and vertebroplasty use, discharge disposition, and postoperative resource utilization across race and insurance status categories. Among 28,803 patients, 7,545 (26.2%) underwent PVA. Compared to White patients, Black patients had the lowest likelihood of receiving PVA, while Hispanic and Asian or Pacific Islander patients had lower odds of receiving PVA. Among patients undergoing PVA, Black patients had higher odds of prolonged hospital stay (OR = 1.54, 95% CI: 1.33–1.78, P < 0.001) and higher costs (OR = 1.24, 95% CI: 1.06–1.45, P = 0.007). Regarding insurance-related disparities, compared with Medicare, Medicaid, private insurance, and self-pay patients also had lower odds of PVA utilization. Medicaid patients had higher odds of prolonged stay and higher costs (OR = 1.20, 95% CI:1.04–1.39, P = 0.01). Privately insured patients had lower costs but higher odds of routine discharge. Racial and insurance-related disparities exist not only in access to PVA but also in postoperative healthcare utilization among patients with OVCF. These findings highlight the importance of addressing disparities across the continuum of care and support efforts to promote equitable access to PVA and postoperative healthcare among underserved populations.