Racial Disparities in Use of Physical Therapy among Elderly with Chronic Back Pain
(School of Public Health (UMD) Epidemiology and Biostatistics Faculty)
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.