The association between sociodemographic characteristics and the event of undergoing first-time, simple lumbar discectomy: A case-control study

BACKGROUND: In disc herniation, nonsurgical treatments are recommended prior to elective discectomy but are often associated with consultation fees, whereas the discectomy itself may be without user payment. This may affect individual preferences in the choice of treatment. This retrospective case-control study examined the association between socioeconomic characteristics and the event of undergoing a first-time, single-level, simple lumbar discectomy. METHODS: The consecutively formed study population comprised patients undergoing elective lumbar discectomy at a Danish public hospital between 2010 and 2013. A national authority identified three gender- and age-matched controls per case for comparison. Measures investigated in this study were marital status, ethnicity, socioeconomic classification, educational level, the extent of sick leave 52 weeks prior to surgery, personal income, and equivalized disposable household income. All measures were provided by national registries. The associations were examined using uni- and multivariate logistic regression analysis. RESULTS: In a study population of 888 operated patients (age (SD) 46 (14); ODI (SD) 47 (18); leg pain intensity (VAS) (iqr) 74 (33), EQ-5D (iqr) 0.26 (0.62)) compared to 2664 controls, the probability of undergoing lumbar discectomy was significantly associated with lower vs. higher educational levels ((OR 1.98-2.53), and with periods of sick leave exceeding two weeks within one year prior to surgery (OR 9.47 (95% CI 7.68-11.68)). In the multivariate analysis, the event of undergoing discectomy was insignificantly associated with any other socioeconomic characteristics, whereas the personal income was of significant importance in the univariate analysis. CONCLUSION: The event of undergoing free-of-fee elective first-time, single-level, simple lumbar discectomy is more common among individuals with low educational levels and unstable labor market attachment when examined in a case-control study. Being a multifactorial challenge, this calls upon the active engagement of several policy sectors.