Journal of neurosurgery. Spine · 2026
Disparities in quality of life and health literacy among patients with degenerative cervical myelopathy: the influence of racial and ethnic factors in the All of Us Research Program.
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Yakdan Salim, Joseph Karan, Poulin Noah, Arkam Faraz, Moniz Garcia Diogo, Cadieux Magalie, Neuman Brian, Goodin Burel R, Godzik Jakub, Steinmetz Michael P, Bydon Mohamad, Ghogawala Zoher, Hafez Daniel, Ray Wilson Z, Greenberg Jacob K
Аннотация
OBJECTIVE: Degenerative cervical myelopathy (DCM) is a progressive condition that results in significant neurological decline and disability. Racial and ethnic disparities in healthcare access and outcomes are well documented, yet their impact on DCM patients remains insufficiently explored. This study aimed to investigate racial and ethnic disparities in self-reported health status and quality of life (QOL), health literacy, and healthcare access among individuals with DCM using data from the All of Us Research Program (AoURP).
METHODS: In this retrospective study, the authors analyzed the data of AoURP participants with a diagnosis of DCM based on ICD-9 and ICD-10 codes. Race and ethnicity were categorized as White/Caucasian (WC), Black/African American (BAA), and non-White Hispanic (NWH). Participants' demographic characteristics, socioeconomic status (SES), self-reported health status and QOL, health literacy, and healthcare utilization patterns were assessed through survey responses. To assess whether SES mediates the association between race and ethnicity and outcomes, a causal mediation analysis was conducted, operationalizing SES as a composite of standardized income, education, and employment measures. Statistical analyses were conducted using chi-square and independent t-tests to compare categorical and continuous variables, respectively.
RESULTS: Among 3092 DCM patients, 26% identified as BAA, 64% as WC, and 10% as NWH. Significant socioeconomic disparities were observed, with WC participants reporting higher educational attainment, income, and homeownership rates (p < 0.001). Healthcare access varied substantially, with BAA and/or NWH participants reporting lower rates of insurance coverage, specialist consultations, and primary care access compared to WC participants (p ≤ 0.05). Financial and transportation barriers to care access were more frequently reported among minority groups. BAA and NWH participants also had lower health literacy, reporting greater difficulty in understanding medical information and completing medical forms and requiring assistance with health materials (p < 0.001). Furthermore, both BAA and NWH groups reported poorer self-perceived health and QOL and higher pain levels (p < 0.001). Causal mediation analysis demonstrated that SES partially mediated the relationship between race and ethnicity and key outcomes, including health literacy, healthcare access, and self-perceived health, indicating that socioeconomic disadvantage explains much, but not all, of the observed disparities.
CONCLUSIONS: This study highlights substantial racial and ethnic disparities in healthcare access, health literacy, and self-reported health status and QOL among DCM patients, which are partially mediated by socioeconomic factors. Recognizing and addressing these disparities is essential to improving DCM outcomes and ensuring equitable care.
METHODS: In this retrospective study, the authors analyzed the data of AoURP participants with a diagnosis of DCM based on ICD-9 and ICD-10 codes. Race and ethnicity were categorized as White/Caucasian (WC), Black/African American (BAA), and non-White Hispanic (NWH). Participants' demographic characteristics, socioeconomic status (SES), self-reported health status and QOL, health literacy, and healthcare utilization patterns were assessed through survey responses. To assess whether SES mediates the association between race and ethnicity and outcomes, a causal mediation analysis was conducted, operationalizing SES as a composite of standardized income, education, and employment measures. Statistical analyses were conducted using chi-square and independent t-tests to compare categorical and continuous variables, respectively.
RESULTS: Among 3092 DCM patients, 26% identified as BAA, 64% as WC, and 10% as NWH. Significant socioeconomic disparities were observed, with WC participants reporting higher educational attainment, income, and homeownership rates (p < 0.001). Healthcare access varied substantially, with BAA and/or NWH participants reporting lower rates of insurance coverage, specialist consultations, and primary care access compared to WC participants (p ≤ 0.05). Financial and transportation barriers to care access were more frequently reported among minority groups. BAA and NWH participants also had lower health literacy, reporting greater difficulty in understanding medical information and completing medical forms and requiring assistance with health materials (p < 0.001). Furthermore, both BAA and NWH groups reported poorer self-perceived health and QOL and higher pain levels (p < 0.001). Causal mediation analysis demonstrated that SES partially mediated the relationship between race and ethnicity and key outcomes, including health literacy, healthcare access, and self-perceived health, indicating that socioeconomic disadvantage explains much, but not all, of the observed disparities.
CONCLUSIONS: This study highlights substantial racial and ethnic disparities in healthcare access, health literacy, and self-reported health status and QOL among DCM patients, which are partially mediated by socioeconomic factors. Recognizing and addressing these disparities is essential to improving DCM outcomes and ensuring equitable care.