Socioeconomic Disparities in Lumbar Fusion Rates Were Exacerbated During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic disrupted healthcare access and utilization throughout the US, with variable impact on patients of different socioeconomic and race. This study characterizes pandemic and pre-pandemic demographic and socioeconomic trends of patients undergoing lumbar spinal fusion surgeries in the United States.

Methods: Adults undergoing first-time lumbar fusion from January 1, 2004, through March 31, 2021, in the de-identified national Clinformatics® Data Mart were assessed for patient age, geographical location, gender, race, education level, net worth, and Charlson Comorbidity Index (CCI) scores. Multivariate regression models were used to evaluate the significance of trends over time.

Results: 217,204 patients underwent lumbar fusions, 2004-2021. The numbers and per capita rates of lumbar fusions increased from 2004 through 2019 and decreased in 2020, the first year of the COVID-19 pandemic, with large variation in geographic distribution. There was overall a significant decrease in White patients undergoing lumbar fusion over time (OR=0.997, p< 0.001), though they were more likely to undergo surgery during the pandemic (OR=1.016, p< 0.001). Patients over time were more likely to be more educated beyond high school. Additionally, patients in the highest (>$500K) and lowest ( <$25K) net worth categories had significantly more fusions over time (p < 0.001). During the pandemic, however, patients in higher net worth groups were more likely to undergo lumbar fusions ($150K-249K & $250K-499K: p< 0.001) whereas patients in the lowest net worth group had decreased rate of surgeries (p < 0.001). Lastly, patients’ CCI increased significantly (coefficient=0.124, p< 0.001), and this trend held true during the pandemic (coefficient=0.179, p< 0.001).

Conclusion : Lumbar fusions decreased overall with the onset of the COVID-19 pandemic. Importantly, existing disparities in patient race, educational attainment, and wealth widened during the pandemic. To the best of our knowledge, our work represents the most comprehensive and recent characterization of socioeconomic variables in lumbar fusion rates, including importantly during the pandemic.