{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:17:43Z","timestamp":1781090263623,"version":"3.54.1"},"reference-count":72,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Databases and Data Treatment<\/jats:title><jats:p>We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non\u2010serious LBP between people from different racial\/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 13 eligible studies; all conducted in the United States. Hispanic\/Latino (OR 0.69, 95%CI 0.49\u20130.96) and Black\/African American (OR 0.59, 95%CI 0.46\u20130.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black\/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33\u20130.67) than White people. There was a lack of high certainty evidence on racial\/ethnic disparities in the use of lumbar imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This review reveals lower rate of the use of guideline\u2010discordant care, especially opioid prescription and spinal surgery, in racial\/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted.<\/jats:p><jats:p><jats:bold>PROSPERO Registration ID<\/jats:bold>: CRD42021260668.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>This systematic review and meta\u2010analysis revealed that people with low back pain from the minority racial\/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.2075","type":"journal-article","created":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T14:59:00Z","timestamp":1672498740000},"page":"476-491","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5651-6717","authenticated-orcid":false,"given":"Qiuzhe","family":"Chen","sequence":"first","affiliation":[{"name":"Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon P.","family":"Vella","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris G.","family":"Maher","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni E.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo C.","family":"Machado","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2009.10.002"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaa258"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.09.009"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2217\/pmt.12.7"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2009.08.003"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200302150-00016"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000696"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000217584.79528.9b"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30725-6"},{"key":"e_1_2_8_11_1","unstructured":"Cochrane L.(2021).Cochrane library\u2010 medical terms (MeSH). Cochrane Library website.https:\/\/www.cochranelibrary.com\/advanced\u2010search\/mesh"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2022.01.008"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.3.23893"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-007-9039-6"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.2006.00107.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05727-z"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2011.3618"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30489-6"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000001203"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.03.017"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.09.011"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.017"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.14120"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30480-X"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2006.01.010"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2011.04.023"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/13557858.2018.1514457"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2022.02.043"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2013.12.015"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-12-78"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00733-9"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.11.064"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.06.014"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.S1.200352"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny074"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-019-00602-y"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.8992"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.2217\/pmt-2018-0030"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002499"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2010.02.023"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2022.152299"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaa427"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.5847\/wjem.j.1920-8642.2015.02.005"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.15205"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5673-2"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2021.06.016"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06750-4"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2007.64"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.2340\/17453674.2022.2272"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2015.11.002"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dym018"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200010010-00004"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200106150-00021"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2020.12.016"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-017-0350-4"},{"issue":"5","key":"e_1_2_8_58_1","first-page":"532","article-title":"When race matters: Disagreement in pain perception between patients and their physicians in primary care","volume":"99","author":"Staton L. J.","year":"2007","journal-title":"Journal of the National Medical Association"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.03.004"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.3847"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.12.2067"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000152115.79236.6e"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-009-9322-2"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(00)70099-0"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099805"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2011.10.014"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2010.06.001"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-03-18-4525"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.0174.x"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2018.0036"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010264.pub2"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2022.07.014"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001875"}],"container-title":["European Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.2075","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejp.2075","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.2075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T19:40:04Z","timestamp":1692646804000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejp.2075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":72,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1002\/ejp.2075"],"URL":"https:\/\/doi.org\/10.1002\/ejp.2075","archive":["Portico"],"relation":{},"ISSN":["1090-3801","1532-2149"],"issn-type":[{"value":"1090-3801","type":"print"},{"value":"1532-2149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]},"assertion":[{"value":"2022-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}