Racial and Ethnic Disparities in Healthcare Affordability, Access, and Provider Concordance for Low Back Pain: An All of Us Cross-Sectional Analysis

Spine J. 2026 Jun 9:S1529-9430(26)00176-2. doi: 10.1016/j.spinee.2026.06.008. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Racial and ethnic disparities in access to musculoskeletal care are well documented, but population-based data specific to low back pain (LBP), the leading cause of disability worldwide, remain limited. Despite the availability of effective treatments, barriers related to affordability, transportation, and cultural concordance continue to influence access to care.

PURPOSE: To evaluate racial and ethnic disparities in affordability and access to healthcare for patients with LBP in the United States and to assess whether these disparities persist after accounting for community-level and individual-level socioeconomic factors.

STUDY DESIGN/SETTING: Cross-sectional study.

PATIENT SAMPLE: A total of 25,006 adults aged ≥18 years reporting LBP were identified from the All of Us Research Program Healthcare Access and Utilization Survey (2018-2025). The cohort included 74.0% White, 9.8% Black, 8.1% Hispanic, and 8.1% Other participants, with a median age of 63 years and 64.0% female representation.

OUTCOME MEASURES: Self-reported affordability barriers, non-financial access barriers, and cultural competence and communication-related barriers to healthcare access.

METHODS: Multivariable logistic regression models examined associations between race or ethnicity and reported barriers to care. Model 1 adjusted for age and sex. Model 2 additionally adjusted for the Community Deprivation Index (CDI). Model 3 further adjusted for individual income and educational attainment. This study received no external funding, and the authors report no study specific conflicts of interest-associated biases.

RESULTS: After adjustment for the Community Deprivation Index, Black and Hispanic participants had higher odds than White participants of reporting inability to afford specialist visits (Black aOR 1.31; Hispanic aOR 1.21), prescription medications (Black aOR 1.54; Hispanic aOR 1.16), and emergency care (Black aOR 1.50), as well as transportation-related delays (Black aOR 2.10; Hispanic aOR 1.78). Both groups also had higher odds of avoiding or delaying care due to differences in provider race, religion, or language (Black aOR 1.66; Hispanic aOR 1.78), and nearly 40% reported never having seen a provider who shared their background. After further adjustment for individual income and education, many cost-related disparities were attenuated, whereas cultural competence and communication-related disparities persisted for both Black and Hispanic participants.

CONCLUSION: Racial and ethnic disparities in access to care for LBP persist beyond both community-level and individual-level socioeconomic disadvantage. Cultural and communication-related barriers remain particularly prominent, underscoring the need for care models that address structural inequities and improve cultural responsiveness.

PMID:42263860 | DOI:10.1016/j.spinee.2026.06.008