OBJECTIVE: Socioeconomic deprivation is increasingly recognized as a determinant of care, yet its relationship to spine surgery remains poorly characterized. The Area Deprivation Index (ADI) provides a validated, neighborhood-level measure of socioeconomic disadvantage. This study characterizes ADI's associations among patients undergoing posterior spine surgery. METHODS: 1,038 adult patients who underwent posterior spine surgery at a quaternary academic center between 2022 and 2024 were included in the retrospective cross-sectional study. National- and state-level ADI ranks were linked to addresses using 9-digit ZIP codes. ADI ranks represent either the percent (national) or decile (state) for any given ZIP code with higher ranks representing worse neighborhood conditions. Associations between ADI and diagnostic category (ICD-10), admission source, demographic variables, and preoperative clinical characteristics were evaluated using nonparametric testing with multiple comparisons using false discovery rate adjustment. Ordinal logistic regression modeled variance in neighborhood deprivation. RESULTS: National-level ADI rank varied significantly between diagnostic categories (p = 0.018, p = 0.374 not significant for State-level ADI rank, Kruskal-Wallis). Patients undergoing surgery for neoplastic pathology demonstrated higher national-level ADI ranks compared with those treated for degenerative disease (q = 0.028). Female sex was also associated with worse state-level ADI rank (p = 0.026, national-rank p = 0.066 ns, Mann-Whitney). In ordinal regression, diagnosis of neoplasm remained independently associated with national ADI rank (OR 1.74, p < 0.001). In the models for both national and state-level ADI rank higher body mass index was also (OR 1.24, p < 0.001 and OR 1.23, p < 0.001 respectively), and female sex (OR 0.77, p = 0.020, OR 0.77, p = 0.018 respectively) were significantly associated with worse ADI ranks. CONCLUSIONS: Among patients undergoing posterior spine surgery, neighborhood socioeconomic deprivation is associated with higher rates of spinal neoplasms, female gender, and larger BMIs. These findings suggest that socioeconomic context influences access to spine surgical care prior to operative intervention and highlight the importance of incorporating neighborhood-level factors into evaluations of spine care delivery. Future studies will examine how these presentation-level disparities relate to postoperative outcomes and resource utilization.
Gluski et al. (Thu,) studied this question.