44. Real world data for spinal cord stimulation - ethnic minorities and social deprivation

Abstract

Background: Health inequality can be influenced by many factors including geography (i.e. access to healthcare services), language and communication barriers, patient preferences, health literacy, waiting times, perceived discrimination and physician bias. Patient ethnicity and language barrier are themes that can often underlie many of these factors. The 2021 UK census showed that 7.1% of the population were proficient in English but did not use it as their main language. 1.5% of the population were unable to speak English well and a further 0.3% of the population were unable to speak English at all. There are certain areas of the UK where the percentage of people unable to speak English was even higher than this national figure (London, Leeds, Manchester, Birmingham - 1.0%, 3.0%, 3.7% and 5.2% respectively). 34% of adults in the UK (Adult Chronic Pain Health Survey, 2017) suffer from some degree of chronic pain. This burden potentially has similar prevalence in the non-English speaking contingent of patients suitable for neuromodulation therapies; however this has not been reported before. This is the first quantification of outcomes in patients with a language barrier highlighting key issues around SCS efficacy in this population. Method(s): After local approval, data from 494 patients (May 2021-June 2022) in a large tertiary inner-city hospital in the UK were reviewed. From this pool, 44 patients were identified (9%) whose native language was not English. 31 patients (70%) in this group were suitable for SCS, highlighting demand for such services amongst ethnic minority groups. Data was analysed from 25 patients who underwent SCS and did not use English as their first language. Result(s): Of the 25 SCS patients that were initially implanted, 2 patients did not comply with questionnaires and an additional 2 patients did not comply with health quality related data collection. 3 patients underwent revision and 2 patients were explanted, giving an explant rate of 8%, which is in higher than our centre's average explant rate of 4% across all types of neuromodulation devices. The mean overall NRS decreased from 7.76 at baseline (n=23) to 4.18 at 12 months (p < 0.0001) (n=19) and mean EQ-5D-5L index scores increased from 0.23 at baseline (n=21) to 0.75 at 12 months (p < 0.0001) (n=17). Similar trends were also evident in the subset of patients that were implanted with a primary cell IPG (n=6). Conclusion(s): The statistically significant improvement in NRS and EQ-5D-5L scores at 12 months validates the need for therapy in this vulnerable group and highlights the growing demand for healthcare to be delivered to patients who cannot communicate in the language of their resident country. The explant rate (8%) and poor compliance with questionnaires (8%) in the ethnic minority population could potentially be attributed to lack of education or language barriers impeding effective dialogue with patients. Despite cultural factors, language barriers and beliefs, as possible confounders, we report successful outcomes at 12 months - highlighting the need for ethnic inclusivity in the context of SCS therapy. Copyright © 2025