Burden of Sciatica on US Medicare Recipients

• Published in: Journal of the American Academy of Orthopaedic Surgeons Vol. 28; no. 10; pp. e433 - e439
• Main Authors: Maslak, Joseph P., Jenkins, Tyler J., Weiner, Joseph A., Kannan, Abhishek S., Patoli, Daneel M., McCarthy, Michael H., Hsu, Wellington K., Patel, Alpesh A.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 15-05-2020; by American Academy of Orthopaedic Surgeons
• ISSN: 1067-151X; 1940-5480
• DOI: 10.5435/JAAOS-D-19-00174

OBJECTIVE:This study evaluates the disease burden of sciatica on the US Medicare cohort.
BACKGROUND DATA:Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes.
METHODS:Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey resultswith or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant.
RESULTS:The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up.
CONCLUSION:A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life.
LEVEL OF EVIDENCE:Level III
STUDY DESIGN:Observational-Cohort Study