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1.
Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.  Spine. 2006;31(23):2724-272717077742PubMedGoogle ScholarCrossref
2.
Gray DT, Deyo RA, Kreuter W,  et al.  Population-based trends in volumes and rates of ambulatory lumbar spine surgery.  Spine. 2006;31(17):1957-196316924213PubMedGoogle ScholarCrossref
3.
Kessler RC, Davis RB, Foster DF,  et al.  Long-term trends in the use of complementary and alternative medical therapies in the United States.  Ann Intern Med. 2001;135(4):262-26811511141PubMedGoogle ScholarCrossref
4.
Carrino JA, Morrison WB, Parker L,  et al.  Spinal injection procedures: volume, provider distribution, and reimbursement in the U.S. Medicare population from 1993 to 1999.  Radiology. 2002;225(3):723-72912461252PubMedGoogle ScholarCrossref
5.
Luo X, Pietrobon R, Hey L. Patterns and trends in opioid use among individuals with back pain in the United States.  Spine. 2004;29(8):884-89015082989PubMedGoogle ScholarCrossref
6.
Cohen SB. Design strategies and innovations in the Medical Expenditure Panel Survey.  Med Care. 2003;41(7):(suppl)  iii5-III1212865722PubMedGoogle Scholar
7.
Cohen JW, Monheit AC, Beauregard KM,  et al.  The Medical Expenditure Panel Survey: a national health information resource.  Inquiry. 1996;33(4):373-3899031653PubMedGoogle Scholar
8.
Medical Expenditure Panel Survey.  Agency for Healthcare Research and Quality Web site. http://www.meps.ahrq.gov/mepsweb. Accessed May 18, 2007
9.
 Medical Expenditure Panel Survey: survey questionnaires—Household Component. Agency for Healthcare Research and Quality Web site. http://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp. Accessibility verified January 17, 2008
10.
Cherkin DC, Deyo RA, Loeser JD. Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases.  Spine. 1992;17(7):817-8251386943PubMedGoogle ScholarCrossref
11.
Luo X, Pietrobon R, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States.  Spine. 2004;29(1):79-8614699281PubMedGoogle ScholarCrossref
12.
Diehr P, Yanez D, Lin DY. Methods for analyzing health care utilization and costs.  Annu Rev Public Health. 1999;20:125-14410352853PubMedGoogle ScholarCrossref
13.
Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap.  Stat Med. 2000;19(23):3219-323611113956PubMedGoogle ScholarCrossref
14.
Strine TW, Hootman JM. US National prevalence and correlates of low back and neck pain among adults.  Arthritis Rheum. 2007;57(4):656-66517471542PubMedGoogle ScholarCrossref
15.
Katz S, Akpom CA. Index of ADL.  Med Care. 1976;14(5):(suppl)  116-118132585PubMedGoogle ScholarCrossref
16.
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.  J Am Geriatr Soc. 1983;31(12):721-7276418786PubMedGoogle Scholar
17.
Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.  Med Care. 1996;34(3):220-2338628042PubMedGoogle ScholarCrossref
18.
Ware JE Jr, Kosinski M, Gandek B. How to Score Version 2 of the SF-12® Health Survey. Lincoln, RI: QualityMetric Inc; 2002
19.
 Consumer Price Index calculator. US Bureau of Labor Statistics Web site. http://www.bls.gov/cpi/. Accessed December 7, 2007
20.
Chantala K. Using Stata to Analyze Data From a Sample SurveyChapel Hill, NC: Carolina Population Center; 2001. http://www.cpc.unc.edu/services/computer/presentations/statatutorial/statasvy.pdf. October 1, 2001. Accessibility verified January 16, 2008
21.
StataCorp.  Stata Base Reference Manual, Release 9. College Station, TX: Stata Press; 2005
22.
 Population estimation tables. U.S. Census Bureau Web site. http://www.census.gov/popest/estimates.php. Accessed December 7, 2007
23.
Yelin E, Murphy L, Helmick CG. Medical care expenditures and earnings losses of persons with arthritis and other rheumatic conditions in 2003 with comparisons to 1997.  Arthritis Rheum. 2007;56(5):1397-140717469096PubMedGoogle ScholarCrossref
24.
 NHLBI factbook: direct and indirect costs of illness by major diagnosis, U.S. 2006. National Heart, Lung and Blood Institute Web site. http://www.nhlbi.nih.gov/about/factbook/toc.htm. Accessed May 18, 2007
25.
Hogan P, Dall T, Nikolov P.American Diabetes Association.  Economic costs of diabetes in the US in 2002.  Diabetes Care. 2003;26(3):917-93212610059PubMedGoogle ScholarCrossref
26.
American Heart Association.  Heart Disease and Stroke Statistics—2005 Update. Dallas, TX: American Heart Association; 2005
27.
Grazier KL, Holbrook TL, Kelsey JL, Stauffer RN. The Frequency of Occurrence, Impact, and Cost of Selected Musculoskeletal Conditions in the United StatesChicago, IL: American Academy of Orthopedic Surgeons; 1984:72-80
28.
Frymoyer JW, Durett CL. The economic impact of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. Vol 2. Philadelphia, PA: Lippincott-Raven; 1997
29.
Von Korff M, Deyo RA. Potent opioids for chronic musculoskeletal pain: flying blind?  Pain. 2004;109(3):207-20915157679PubMedGoogle ScholarCrossref
30.
 Promoting pain relief and preventing abuse of pain medications: a critical balancing act: a joint statement from 21 health organizations and the Drug Enforcement Administration. American Pain Society Web site. http://www.ampainsoc.org/advocacy/promoting.htm. Accessed May 18, 2007
31.
 The use of opioids for the treatment of chronic pain: a consensus statement from American Academy of Pain Medicine and American Pain Society. American Pain Society Web site. http://www.ampainsoc.org/advocacy/opioids.htm. Accessed May 18, 2007
32.
Savage SR, Joranson DE, Covington EC, Schnoll SH, Heit HA, Gilson AM. Definitions related to the medical use of opioids: evolution towards universal agreement.  J Pain Symptom Manage. 2003;26(1):655-66712850648PubMedGoogle ScholarCrossref
33.
Zerzan JT, Morden NE, Soumerai S,  et al.  Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs, 1996 to 2002.  Med Care. 2006;44(11):1005-101017063132PubMedGoogle ScholarCrossref
34.
Weiner DK, Kim YS, Bonino P, Wang T. Low back pain in older adults: are we utilizing healthcare resources wisely?  Pain Med. 2006;7(2):143-15016634727PubMedGoogle ScholarCrossref
35.
Friedly J, Chan L, Deyo RA. Increases in lumbosacral injections in the Medicare population, 1994 to 2001.  Spine. 2007;32(16):1754-176017632396PubMedGoogle ScholarCrossref
36.
Deyo RA, Gray DT, Kreuter W, Mirza SK, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions.  Spine. 2005;30(12):1441-144515959375PubMedGoogle ScholarCrossref
37.
Deyo RA, Mirza SK. Trends and variations in the use of spine surgery.  Clin Orthop Relat Res. 2006;443:139-14616462438PubMedGoogle ScholarCrossref
38.
Feuerstein M, Marcus SC, Huang GD. National trends in nonoperative care for nonspecific back pain.  Spine J. 2004;4(1):56-6314749194PubMedGoogle ScholarCrossref
Original Contribution
February 13, 2008

Expenditures and Health Status Among Adults With Back and Neck Problems

Author Affiliations

Author Affiliations: Departments of Orthopaedics and Sports Medicine (Mr Martin and Dr Mirza), Health Sciences (Mr Martin and Dr Sullivan), Psychiatry and Behavioral Sciences (Dr Turner), Radiology (Mr Comstock), and Pharmacy (Dr Sullivan), University of Washington, Seattle; Department of Family Medicine, Oregon Health & Science University, Portland (Dr Deyo); and Center for Cost and Outcomes Research, University of Washington, Seattle (Mssrs Martin and Comstock and Drs Deyo, Mirza, Turner, Hollingworth, and Sullivan).

JAMA. 2008;299(6):656-664. doi:10.1001/jama.299.6.656
Abstract

Context Back and neck problems are among the symptoms most commonly encountered in clinical practice. However, few studies have examined national trends in expenditures for back and neck problems or related these trends to health status measures.

Objectives To estimate inpatient, outpatient, emergency department, and pharmacy expenditures related to back and neck problems in the United States from 1997 through 2005 and to examine associated trends in health status.

Design and Setting Age- and sex-adjusted analysis of the nationally representative Medical Expenditure Panel Survey (MEPS) from 1997 to 2005 using complex survey regression methods. The MEPS is a household survey of medical expenditures weighted to represent national estimates. Respondents were US adults (> 17 years) who self-reported back and neck problems (referred to as “spine problems” based on MEPS descriptions and International Classification of Diseases, Ninth Revision, Clinical Modification definitions).

Main Outcome Measures Spine-related expenditures for health services (inflation-adjusted); annual surveys of self-reported health status.

Results National estimates were based on annual samples of survey respondents with and without self-reported spine problems from 1997 through 2005. A total of 23 045 respondents were sampled in 1997, including 3139 who reported spine problems. In 2005, the sample included 22 258 respondents, including 3187 who reported spine problems. In 1997, the mean age- and sex-adjusted medical costs for respondents with spine problems was $4695 (95% confidence interval [CI], $4181-$5209), compared with $2731 (95% CI, $2557-$2904) among those without spine problems (inflation-adjusted to 2005 dollars). In 2005, the mean age- and sex- adjusted medical expenditure among respondents with spine problems was $6096 (95% CI, $5670-$6522), compared with $3516 (95% CI, $3266-$3765) among those without spine problems. Total estimated expenditures among respondents with spine problems increased 65% (adjusted for inflation) from 1997 to 2005, more rapidly than overall health expenditures. The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7% (95% CI, 19.9%-21.4%) to 24.7% (95% CI, 23.7%-25.6%) from 1997 to 2005. Age- and sex-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.

Conclusions In this survey population, self-reported back and neck problems accounted for a large proportion of health care expenditures. These spine-related expenditures have increased substantially from 1997 to 2005, without evidence of corresponding improvement in self-assessed health status.

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