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Expenditures rising for back and neck problems, but health outcomes do not appear to be improving

February 13, 2008

Although expenses related to back and neck problems have increased substantially in the last decade, outcomes such as functional disability and work limitations do not appear to be improving, according to a study in the February 13 issue of JAMA.

Back and neck problems are among the symptoms most commonly encountered in clinical practice. In a 2002 survey of U.S. adults, 26 percent reported low back pain and 14 percent reported neck pain in the previous three months, according to background information in the article. Rates of imaging and therapy for back and neck (spine) problems have increased substantially in the last decade, but it is not clear how this has effected expenditures or health outcomes for individuals with these problems.

Brook I. Martin, M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to examine changes in expenditures and health status related to spine problems. The researchers analyzed 1997 - 2005 data from the nationally representative Medical Expenditure Panel Survey (MEPS). A total of 23,045 respondents (U.S. adults older than 17 years) were sampled in 1997, including 3,139 who reported spine problems. In 2005, the sample included 22,258 respondents, including 3,187 who reported spine problems.

The researchers found that expenditures were higher in each year for those with spine problems than for those without. In 1997,the average age- and sex-adjusted medical costs for respondents with spine problems was $4,695, compared with $2,731 among those without spine problems (inflation adjusted to 2005 dollars). In 2005, the average age- and sex-adjusted medical expenditures among respondents with spine problems was $6,096, compared with $3,516 among those without spine problems. From 1997 to 2005, these trends resulted in an estimated 65 percent inflation-adjusted increase in the total national expenditure of adults with spine problems, a more rapid increase than overall health expenditures.

Most of the difference observed in inflation-adjusted expenditures between those with and without spine problems in 2005 was accounted for by outpatient services (36 percent) and inpatient services (28 percent). Smaller proportions were accounted for by prescription medications (23 percent); emergency department visits (3 percent); and home health, dental and other expenses (10 percent).

The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7 percent to 24.7 percent from 1997 to 2005. Adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.

"These data suggest that spine problems are expensive, due both to large numbers of affected persons and to high costs per person. We did not observe improvements in health outcomes commensurate with the increasing costs over time. Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes," the authors conclude.

JAMA and Archives Journals