Socioeconomic differences in the utilization of diagnostic imaging and non-pharmaceutical conservative therapies for spinal diseases

Research output: Contribution to journalResearch articleContributedpeer-review



BACKGROUND: A different utilization of health care services due to socioeconomic status on the same health plan contradicts the principle of equal treatment. We investigated the presence and magnitude of socioeconomic differences in utilization of diagnostic imaging and non-pharmaceutical conservative therapies for patients with spinal diseases. METHODS: The cohort study based on routine healthcare data from Germany with 11.7 million patient-years between 2012 and 2016 for patients with physician-confirmed spinal diseases (ICD-10: M40-M54), occupation and age 20 to 64 years. A Poisson model estimated the effects of the socioeconomic status (school education, professional education and occupational position) for the risk ratio of receiving diagnostic imaging (radiography, computed tomography, magnetic resonance imaging) and non-pharmaceutical conservative therapies (physical therapy including exercise therapy, manual therapy and massage, spinal manipulative therapy, acupuncture). RESULTS: Patients received diagnostic imaging in 26%, physical therapy in 32%, spinal manipulative therapy in 25%, and acupuncture in 4% of all patient-years. Similar to previous survey-based studies higher rates of utilization were associated with higher socioeconomic status. These differences were most pronounced for manual therapy, exercise therapy, and magnetic resonance imaging. CONCLUSIONS: The observed differences in health care utilization were highly related to socioeconomic status. Socioeconomic differences were higher for more expensive health services. Further research is necessary to identify barriers to equitable access to health services and to take appropriate action to decrease existing social disparities.


Original languageEnglish
Article number774
Number of pages1
JournalBMC musculoskeletal disorders
Issue number1
Publication statusPublished - Oct 2023

External IDs

RIS Tesch2023
ORCID /0000-0002-8671-7496/work/143783446
Scopus 85173034974
PubMed 37784063


Research priority areas of TU Dresden


  • Adult, Cohort Studies, Conservative Treatment, Humans, Manipulation, Spinal/methods, Middle Aged, Social Class, Socioeconomic Factors, Spinal Diseases/diagnostic imaging, Tomography, X-Ray Computed, Young Adult