Introduction: Care and outcomes for patients with chronic low back pain (cLBP) are influenced by the social risk factors that they experience. Social risk factors such as food insecurity and housing instability have detrimental effects on patient health and wellness, healthcare outcomes, and health disparities.

Objectives: This retrospective cross-sectional study examined how social risk factors identified in unstructured and structured electronic health record (EHR) data for 1,295 patients with cLBP were associated with health care utilization. We also studied the impact of social risk factors, controlling for back pain-related disability on health care utilization.

Methods: Included patients who received outpatient spine and/or physical therapy services at an urban academic medical center between 2018 and 2020. Five identified social risks were financial insecurity, housing instability, food insecurity, transportation barriers, and social isolation. Outcomes included 4 categories of health care utilization: emergency department (ED) visits/hospitalizations, imaging, outpatient specialty visits related to spine care, and physical therapy (PT) visits. Poisson regression models tested associations between the presence of identified social risks and each outcome measure.

Results: Identified social risks in 12.8% of the study population (N = 166/1,295). In multivariate models, social isolation was positively associated with imaging, specialty visits, and PT visits; housing instability was positively associated with ED visits/hospitalizations and imaging; food insecurity was positively associated with ED visits/hospitalizations and specialty visits but negatively associated with PT visits; and financial strain was positively associated with PT visits but negatively associated with ED visits/hospitalization.

Conclusion: These associations were seen above and beyond other factors used as markers of socioeconomic marginalization, including neighborhood-level social determinants of health, race/ethnicity, and insurance type. Identifying and intervening on social risk factors that patients with cLBP experience may improve outcomes and be cost-saving.

Keywords: Chronic low back pain; Health care utilization; Physical therapy rehabilitation; Social determinants of health; Social risk factors.

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

简介： 慢性下背痛（cLBP）患者的护理和预后会受到他们经历的社会风险因素的影响。社会风险因素如食物不安全和住房不稳定对患者健康、福祉以及医疗结果和社会差异具有负面影响。

目的： 这项回顾性横断面研究考察了1295名慢性下背痛（cLBP）患者的未结构化和结构化的电子健康记录（EHR）数据中识别出的社会风险因素与医疗服务利用之间的关联。我们还研究了在控制与背部疼痛相关残疾的情况下，社会风险因素对医疗服务利用的影响。

方法： 纳入2018年至2020年间在一个城市学术医学中心接受门诊脊柱和/或物理治疗服务的患者。识别出的社会风险包括财务不安全、住房不稳定、食物不安全、交通障碍和社会孤立。结果包括4类医疗服务利用：急诊科（ED）就诊/住院，成像检查，与脊柱护理相关的专科门诊访问，以及物理治疗（PT）访问。泊松回归模型测试了已识别社会风险的存在与每个结局测量之间的关联。

结果： 在研究人群中12.8%的患者（N = 166/1,295）被识别出存在社会风险。多变量模型中，社会孤立与成像、专科就诊和PT访问呈正相关；住房不稳与ED访问/住院和成像检查呈正相关；食物不安全与ED访问/住院和专科就诊呈正相关但与PT访问呈负相关；财务压力则与PT访问呈正相关但与ED访问/住院呈负相关。

结论： 这些关联在超出其他用于标记社会经济边缘化因素（包括社区水平的社会决定因素、种族/民族和保险类型）的情况下被观察到。识别并干预慢性下背痛患者经历的社会风险因素可能会改善预后并具有成本效益。

关键词： 慢性下背痛；医疗服务利用；物理治疗康复；社会健康决定因素；社会风险因素。