Socioeconomic and Racial/ethnic Disparities in Perception of Health Status and Literacy in Spondylolisthesis Patients: insights from the All of Us Research Program

Introduction: Spondylolisthesis patients comprise a vulnerable population. The aim of this study was to assess the socioeconomic and racial/ethnic disparities on perception of health status/literacy in patients with spondylolisthesis.

Methods: A retrospective cohort study was performed using the National Institutes of Health All of Us survey database. Adults with spondylolisthesis were identified using ICD-9/10 codes. Patients were categorized based on race/ethnicity: White/Caucasian (W/C), Black/African-American (B/AA), and Non-White Hispanic (NWH). Patient demographics were assessed. Responses to questionnaires regarding baseline health status, perception of health status, health information understanding/literacy, and barriers to healthcare were assessed.

Results: Of the 2,717 patients identified, 553 (20.5%) were B/AA, 390 (14.4%) were NWH, and 1,774 (65.3%) were W/C. W/C patients reported higher levels of education (p < 0.001), annual income greater than $50K (p < 0.001), and home ownership (p < 0.001) than B/AA and NWH patients. B/AA and NWH patients reported greater rates of 7-day “10/10 pain” (p < 0.001) and lower rates of being “Completely” able to perform everyday activities (p < 0.001). A greater proportion of W/C patients rated their General Health (p=0.006) and Health Quality (p < 0.001) as “Excellent” than other cohorts. The W/C cohort had a greater proportion of patients reporting “Never” experiencing difficulty understanding health material (p < 0.001) or needing assistance with the health material (p < 0.001). Additionally, a lower proportion of B/AA and NWH patients reported feeling “Extremely” confident with completing medical forms (p < 0.001). A greater proportion of B/AA and NWH patients reported feeling “Somewhat Worried” about paying for healthcare (p < 0.001), though a greater proportion of B/AA and W/C patients reported delaying medical care citing “Can’t Afford Co-pay” (p=0.003).

Conclusion : We identified disparities in perception of health literacy/status among spondylolisthesis patients, with Black and Hispanic patients being more likely to report lower health literacy/status than White patients.