{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T07:24:22Z","timestamp":1777620262517,"version":"3.51.4"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>To determine the association between race and access to healthcare services with respect to the treatment of spinal cord disorders, a retrospective cohort study of patients receiving an initial diagnosis, two Boston hospitals, September 1, 2017, to June 1, 2018, follow-up through December 31, 2019. Data from patients (18\u201389 years) diagnosed with spinal cord disorders were extracted retrospectively from a centralized database. Kaplan-Meier curves and multivariable Cox proportional hazards models analyzed the time to spine surgery following initial diagnosis. Patient race was the primary explanatory variable, with five racial groups (Asian, Black, Hispanic, Other, and White) based on a combination of their self-reported race and ethnicity. Hispanic ethnicity (regardless of race), non-Hispanic ethnicity (designated Asian, Black, or White), and \u201cOther\u201d (non-Hispanic patients who designated their race as other than Asian, Black, or White; this included American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, or two or more races). Among 56,186 patients (4% Asian, 7% Black, 5% Hispanic, 6% Other, 77% White) meeting inclusion criteria, Asian (hazard ratio (HR) 0.67 (0.55, 0.82)), Black (HR 0.55 (0.47, 0.63)), Hispanic (HR 0.43 (0.35, 0.52)), and Other (HR 0.59 (0.51, 0.69)) patients had significantly longer times to surgery compared with White patients.<\/jats:p>","DOI":"10.1371\/journal.pone.0325810","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T17:23:14Z","timestamp":1751304194000},"page":"e0325810","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed surgery among patients diagnosed with spinal disorders: Retrospective analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6336-0634","authenticated-orcid":true,"given":"Linda S.","family":"Aglio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tayisha","family":"Examond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel A.","family":"Justice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Mendez-Pino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-0342","authenticated-orcid":true,"given":"Elisabetta","family":"Mezzalira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah A.","family":"Baez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole J.","family":"Kelly-Aglio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara G.","family":"Fields","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert N.","family":"Jamison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert R.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M.","family":"Corey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"issue":"4","key":"pone.0325810.ref001","first-page":"75","article-title":"Understanding and addressing racial disparities in health care","volume":"21","author":"DR Williams","year":"2000","journal-title":"Health Care Financ Rev"},{"issue":"2","key":"pone.0325810.ref002","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000479480","article-title":"Health Disparities in Kidney Transplantation for African Americans","volume":"46","author":"K Harding","year":"2017","journal-title":"Am J Nephrol"},{"issue":"5","key":"pone.0325810.ref003","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00005082-200609000-00007","article-title":"Racial disparities in outcomes following coronary artery bypass grafting","volume":"21","author":"M Hravnak","year":"2006","journal-title":"J Cardiovasc Nurs"},{"issue":"5","key":"pone.0325810.ref004","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.apmr.2007.02.002","article-title":"Symptom burden in persons with spinal cord injury","volume":"88","author":"MP Jensen","year":"2007","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"pone.0325810.ref005","first-page":"242","article-title":"Evidence-based evaluation of physiological effects of standing and walking in individuals with spinal cord injury","volume":"36","author":"MT Karimi","year":"2011","journal-title":"Iran J Med Sci"},{"key":"pone.0325810.ref006","doi-asserted-by":"crossref","first-page":"910","DOI":"10.31616\/asj.2020.0593","article-title":"Diagnostic Modality in Spine Disease: A Review","volume":"14","author":"G-U Kim","year":"2020","journal-title":"Asian Spine J"},{"issue":"2","key":"pone.0325810.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0032037","article-title":"Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)","volume":"7","author":"MG Fehlings","year":"2012","journal-title":"PLoS One"},{"issue":"3","key":"pone.0325810.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamcollsurg.2012.11.014","article-title":"Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors","volume":"216","author":"AH Haider","year":"2013","journal-title":"J Am Coll Surg"},{"key":"pone.0325810.ref009","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/01.brs.0000152115.79236.6e","article-title":"Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background","volume":"30","author":"BA Taylor","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"pone.0325810.ref010","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1186\/s12913-020-05698-1","article-title":"The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey","volume":"20","author":"AB Ross","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0325810.ref011","article-title":"Trends in obesity and adiposity measures by race or ethnicity among adults in the United States 2011-18: population based study","volume":"372","author":"B Liu","year":"2021","journal-title":"BMJ"},{"key":"pone.0325810.ref012","unstructured":"ZIP Code Lookup - MCDC. https:\/\/mcdc.missouri.edu\/applications\/zipcodes\/."},{"issue":"6","key":"pone.0325810.ref013","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"H Quan","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"11","key":"pone.0325810.ref014","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s10654-021-00802-z","article-title":"Methodical considerations on adjusting for Charlson Comorbidity Index in epidemiological studies","volume":"36","author":"S M\u00f6ller","year":"2021","journal-title":"Eur J Epidemiol"},{"issue":"11","key":"pone.0325810.ref015","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"H Quan","year":"2005","journal-title":"Med Care"},{"issue":"20","key":"pone.0325810.ref016","doi-asserted-by":"crossref","first-page":"3832","DOI":"10.1002\/sim.8206","article-title":"Adjusted restricted mean survival times in observational studies","volume":"38","author":"SC Conner","year":"2019","journal-title":"Stat Med"},{"issue":"3","key":"pone.0325810.ref017","article-title":"mice: Multivariate Imputation by Chained Equations inR","volume":"45","author":"van Buuren S","year":"2011","journal-title":"J Stat Soft"},{"issue":"3","key":"pone.0325810.ref018","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jamcollsurg.2018.12.028","article-title":"Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map","volume":"228","author":"E de Jager","year":"2019","journal-title":"J Am Coll Surg"},{"issue":"1","key":"pone.0325810.ref019","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s12889-019-6577-8","article-title":"Transportation barriers to access health care for surgical conditions in Malawi a cross sectional nationwide household survey","volume":"19","author":"C Varela","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0325810.ref020","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/s41746-022-00695-6","article-title":"Addressing racial disparities in surgical care with machine learning","volume":"5","author":"J Halamka","year":"2022","journal-title":"NPJ Digit Med"},{"issue":"5","key":"pone.0325810.ref021","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s00268-011-1010-1","article-title":"Systematic review of barriers to surgical care in low-income and middle-income countries","volume":"35","author":"CE Grimes","year":"2011","journal-title":"World J Surg"},{"key":"pone.0325810.ref022","unstructured":"Keisler-Starkey K, Bunch LN. Health Insurance Coverage in the United States: 2021."},{"key":"pone.0325810.ref023","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1146\/annurev-publhealth-052620-103528","article-title":"Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs","volume":"43","author":"MB Vela","year":"2022","journal-title":"Annu Rev Public Health"},{"issue":"2","key":"pone.0325810.ref024","first-page":"151","article-title":"Racial\/ethnic disparities in health: the interplay between discrimination and socioeconomic status","volume":"9","author":"XS Ren","year":"1999","journal-title":"Ethn Dis"},{"key":"pone.0325810.ref025","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/01.mlr.0000156849.15166.ec","article-title":"Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000","volume":"43","author":"PW Groeneveld","year":"2005","journal-title":"Med Care"},{"issue":"3","key":"pone.0325810.ref026","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jacc.2010.09.027","article-title":"The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists","volume":"57","author":"CW Yancy","year":"2011","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"pone.0325810.ref027","doi-asserted-by":"crossref","first-page":"430","DOI":"10.4055\/cios20019","article-title":"Racial Disparity in Time to Surgery and Complications for Hip Fracture Patients","volume":"12","author":"SK Nayar","year":"2020","journal-title":"Clin Orthop Surg"},{"issue":"3","key":"pone.0325810.ref028","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1227\/neu.0000000000002925","article-title":"Disparities in Surgical Intervention and Health-Related Quality of Life Among Racial\/Ethnic Groups With Degenerative Lumbar Spondylolisthesis","volume":"95","author":"E Massaad","year":"2024","journal-title":"Neurosurgery"},{"issue":"3","key":"pone.0325810.ref029","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1148\/radiol.2016152055","article-title":"Spinal Injections for Pain Management","volume":"281","author":"WE Palmer","year":"2016","journal-title":"Radiology"},{"issue":"8","key":"pone.0325810.ref030","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1089\/neu.2009.1236","article-title":"The role of magnetic resonance imaging in the management of acute spinal cord injury","volume":"28","author":"A Bozzo","year":"2011","journal-title":"J Neurotrauma"},{"issue":"6","key":"pone.0325810.ref031","doi-asserted-by":"crossref","first-page":"725","DOI":"10.15537\/smj.2015.6.11095","article-title":"Prevalence of spinal disorders and their relationships with age and gender","volume":"36","author":"AM Alshami","year":"2015","journal-title":"Saudi Med J"},{"issue":"1","key":"pone.0325810.ref032","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3122\/jabfm.2009.01.080102","article-title":"Overtreating chronic back pain: time to back off?","volume":"22","author":"RA Deyo","year":"2009","journal-title":"J Am Board Fam Med"},{"issue":"1","key":"pone.0325810.ref033","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.29238","article-title":"Assessment of Racial Disparities in Primary Care Physician Specialty Referrals","volume":"4","author":"BE Landon","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"10","key":"pone.0325810.ref034","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzac095","article-title":"Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain","volume":"102","author":"RR Richter","year":"2022","journal-title":"Phys Ther"},{"key":"pone.0325810.ref035","article-title":"Racial and ethnic disparities in inpatient interventional pain management for lumbar radiculopathy","volume":"26","author":"R Louis","year":"2023","journal-title":"Pain Physician"},{"issue":"4","key":"pone.0325810.ref036","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s40615-016-0263-7","article-title":"Disparities in Access to Outpatient Rehabilitation Therapy for African Americans with Arthritis","volume":"4","author":"R Sandstrom","year":"2017","journal-title":"J Racial Ethn Health Disparities"},{"issue":"5","key":"pone.0325810.ref037","doi-asserted-by":"crossref","first-page":"497","DOI":"10.2522\/ptj.20050218","article-title":"Use of outpatient physical therapy services by people with musculoskeletal conditions","volume":"87","author":"SK Carter","year":"2007","journal-title":"Phys Ther"},{"key":"pone.0325810.ref038","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1037\/a0016059","article-title":"Perceived Discrimination and Health: A Meta-Analytic Review","volume":"135","author":"EA Pascoe","year":"2009","journal-title":"Psychol Bull"},{"key":"pone.0325810.ref039","author":"PR Center","year":"2016"},{"issue":"1","key":"pone.0325810.ref040","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.pmn.2017.11.008","article-title":"Pain, Racial Discrimination, and Depressive Symptoms among African American Women","volume":"19","author":"JL Walker Taylor","year":"2018","journal-title":"Pain Manag Nurs"},{"key":"pone.0325810.ref041","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s10865-008-9160-9","article-title":"The association of perceived discrimination with low back pain","volume":"31","author":"RR Edwards","year":"2008","journal-title":"J Behav Med"},{"issue":"9","key":"pone.0325810.ref042","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1097\/j.pain.0000000000000957","article-title":"Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women\u2019s Health Across the Nation","volume":"158","author":"SA Dugan","year":"2017","journal-title":"Pain"},{"issue":"8","key":"pone.0325810.ref043","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1111\/j.1526-4637.2009.00742.x","article-title":"The effect of perceived racial discrimination on bodily pain among older African American men","volume":"10","author":"DJ Burgess","year":"2009","journal-title":"Pain Med"},{"issue":"6","key":"pone.0325810.ref044","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jpain.2015.03.003","article-title":"The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions","volume":"16","author":"AT Hirsh","year":"2015","journal-title":"J Pain"},{"key":"pone.0325810.ref045","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.pain.2009.02.005","article-title":"Pain assessment and treatment disparities: a virtual human technology investigation","volume":"143","author":"AT Hirsh","year":"2009","journal-title":"Pain"},{"issue":"5","key":"pone.0325810.ref046","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/136140960300800505","article-title":"Perspectives on pain: A qualitative analysis of the Hispanic pain experience","volume":"8","author":"GD Sherwood","year":"2003","journal-title":"NT Research"},{"issue":"5","key":"pone.0325810.ref047","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jpain.2004.12.008","article-title":"Access to care for chronic pain: racial and ethnic differences","volume":"6","author":"M Nguyen","year":"2005","journal-title":"J Pain"},{"key":"pone.0325810.ref048","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/00005650-199204000-00001","article-title":"Instrumental and affective aspects of physician behavior","volume":"30","author":"JM Bensing","year":"1992","journal-title":"Med Care"},{"key":"pone.0325810.ref049","article-title":"The expression of emotion through nonverbal behavior in medical visits. Mechanisms and outcomes","author":"DL Roter","year":"2006","journal-title":"J Gen Intern Med"},{"issue":"4","key":"pone.0325810.ref050","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1001\/jama.1997.03540280088045","article-title":"Communication patterns of primary care physicians","volume":"277","author":"DL Roter","year":"1997","journal-title":"JAMA"},{"issue":"16","key":"pone.0325810.ref051","doi-asserted-by":"crossref","first-page":"4296","DOI":"10.1073\/pnas.1516047113","article-title":"Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites","volume":"113","author":"KM Hoffman","year":"2016","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"10","key":"pone.0325810.ref052","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1097\/j.pain.0000000000002948","article-title":"Race differences in pain and pain-related risk factors among former professional American-style football players","volume":"164","author":"RR Edwards","year":"2023","journal-title":"Pain"},{"key":"pone.0325810.ref053","year":"2018"},{"key":"pone.0325810.ref054","author":"Health Care Costs"},{"key":"pone.0325810.ref055","unstructured":"Ansong-DePass L. A cut above the rest: A qualitative study to evaluate the feasibility of implementing early childhood mental health interventions into Boston Black\/African American barbershops and beauty salons. 2022;15."},{"key":"pone.0325810.ref056","unstructured":"Little L, Wallace DC, Poole KJ. Promoting mammography screenings in African American women: media, church, and health providers. 2023;16."},{"key":"pone.0325810.ref057","unstructured":"Lee MS, Peart JR, Armin JS, Williamson HJ. A scoping review of barriers and facilitators to pap testing in women with disabilities and serious mental illnesses: thirty years after the Americans with Disabilities Act. 2021;14."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325810","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T17:23:26Z","timestamp":1751304206000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325810"}},"subtitle":[],"editor":[{"given":"Alvan-Emeka K.","family":"Ukachukwu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":57,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0325810","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}