The relation of race to outcomes and the use of health care services for acute low back pain

Study Design. Four strata of randomly selected health care providers in North Carolina (primary care MDs, Doctors of Chiropractic, orthopedic surgeons, and group model HMO primary care providers) enrolled 1633 consecutive patients with low back pain into the cohort study. Objective. To determine whether race had an independent effect on rate of recovery from low back pain, and whether there was any racial disparity in the treatments provided to patients with low back pain. Summary of Background Data. Little research to date has examined the relation between patient race and recovery from an episode of acute low back pain. Methods. Consecutive patients were enrolled in the provider's office and contacted by telephone at baseline, at 2, 4, 8, 12, and 24 weeks, and at 22 months. Results. Blacks (n = 238) at baseline had higher pain scores on a 10-point scale (5.92 vs 5/25; P < 0.01) and worse functional disability (12.1 vs 11; P = 0.04), as assessed by the 23-point Roland-Morris scale, yet were considered by their health provider as having less severe pain and less likely to have disc disease than white patients (P < 0.05 for all comparisons). Blacks had worse functional disability at most follow-up interviews. Blacks were shown to be less likely to receive radiographs (49% vs 40%) or advanced imaging studies (10% vs 6%), even after controlling for income, education, baseline severity of low back pain, and insurance status (P < 0.05). Doctors of Chiropractic had different practice approaches than MDs, and there was an interaction with patient race. Conclusions. The relation of patient race to outcomes from and care for low back pain is complex. Blacks have slightly worse functional status than whites on presentation and at follow-up assessment. Blacks receive less intense diagnostic and treatment approaches from MDs, although the severity of their impairment is at least as great.