Online Program

Racial Disparities in Use of Physical Therapy among Elderly with Chronic Back Pain

Monday, November 2, 2015

Olivia Carter-Pokras, PhD, Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD
Jie Chen, PhD, Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD
Objective: Examine racial/ethnic disparities in use of physical therapy among elderly adults with chronic back pain.

Methods: Cross-sectional study using Medical Expenditure Panel Survey (2000-2012). Means comparison, multivariate logistic regression, and Blinder-Oaxaca decomposition techniques were used to estimate the likelihood of receiving any physical therapy by race/ethnicity.

Population Studied: Elderly adults (>=65 years), with diagnosis of back pain (ICD9=724), who self-reported having pain for more than 12 months. Our sample included 3,375 Non-Hispanic Whites (Whites), 426 Non-Hispanic Blacks (Blacks), and 439 Hispanics.

Results: White seniors with chronic back pain (19.9%) were more likely to receive physical therapy than Blacks (9.9%) or Hispanics (13.4%). After taking into account socioeconomic and other access factors, Blacks with chronic back pain remained less likely to receive physical therapy than Whites (OR=0.49, p<.01). Seniors with chronic back pain who reported very good/excellent mental health (p<.01), were women (p=.02), and/or had at least 12 years of education (p<.01) were significantly more likely to receive physical therapy than other seniors. Decomposition results showed that family income was the major reason associated with disparities among Whites vs. Blacks.

Implications for Policy, Delivery or Practice: Moderate evidence exists that post-treatment exercises can reduce back pain recurrences (Choi, Verbeek, Tam, Jiang, 2011). Although medically necessary outpatient physical therapy is covered under Medicare Part B ($1,940 for physical therapy in 2015), our findings suggest that socioeconomic factors drive racial disparities in receipt of physical therapy for chronic back pain, providing further evidence to support the upcoming National Pain Strategy.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Other professions or practice related to public health
Public health or related research

Learning Objectives:
Identify factors associated with receipt of physical therapy for chronic back pain among the elderly. Describe whether racial disparities exist in receipt of physical therapy for chronic back pain among the elderly. Discuss possible reasons for observed disparities.

Keyword(s): Health Disparities/Inequities, Physical Activity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator for a University of Maryland ADVANCE Interdisciplinary and Engaged Research seed grant to study Racial and Ethnic Disparities in Utilization of Physical Therapy among Adults with Chronic Low Back Pain. I have served on the Institute of Medicine committee on Advancing Pain Research, Care, and Education, and the National Institutes of Health's Interagency Pain Research Coordinating Committee’s Population Research working group.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.