Cervical/Neck Pain

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Lead Author(s): 

Kern Singh, MD
Gunnar Andersson, MD, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Cervical/neck pain is another common reason for visiting a doctor. In 2013, 21.4 million patient visits, or 1.8% of all healthcare visits to hospitals and physician offices, were for neck pain. Three out of four (73%) of these were physician visits, while only a small number (3%) of patients with neck pain were hospitalized. (Reference Table 2A.4.1 PDF CSV)

Cervical disorders accounted for the majority (72%) of healthcare visits for neck pain in 2013. Neck disorders are primarily treated in outpatient clinics or physician offices but are also responsible for the highest percentage of hospital discharges (65%) for neck pain. Cervical disc disorders accounted for only 16% of all neck pain healthcare visits in 2013 but were responsible for one-third of hospitalizations (32%). Neck injuries accounted for 22% of all neck pain healthcare visits. This is a much higher percentage than that reported for low back injuries. Patients with neck injuries were primarily treated in an outpatient setting and represented 46% of all emergency department visits for neck pain and approximately one out of every five hospital outpatient and physician office visits. (Reference Table 2A.3.1 PDF CSV)


Demographics of Cervical/Neck Pain

The data on cervical/neck pain shows that hospital discharges are rare in people younger than age 18 years. When adjusted for the US 2013 Census population, estimates for hospital discharges are highest in the 45-64 years age group. The average age for persons hospitalized for neck pain was 59.8 years. Emergency department visits occurred most frequently in patients aged 18-44 years with an average age of 44.3 years. The average age of patients for hospital outpatient and physician office visits was 49.9 years and 51.9 years of age, respectively. (Reference Table 2A.3.2 PDF CSV)

Almost four of five neck pain diagnoses (77.2%) in 2013 occurred in persons between ages of 18 and 64 years. Almost one in five patients (19.7%) were older than 65 years, and only 3.1% were younger than 18 years of age, although this group represents 24% of the US population. The diagnosis category of "cervical disorders" dominated over cervical disc disorders and cervical injury diagnoses categories among total healthcare visits for neck and cervical spine disorders in all age groups. When comparing age groups, patients younger than 18 and patients aged 18-44 years experienced a larger percentage of neck injuries relative to all neck pain visits, 33.3% and 36.4%, respectively. (Reference Table 2A.3.2 PDF CSV)

In 2013, females accounted for 59% of the healthcare visits for neck pain overall, 59% of cervical disorder visits, and 62% of neck injury visits. Males accounted for 53% of the visits for cervical disc disorders. (Reference Table 2A.3.1 PDF CSV)

Non-Hispanic black and Hispanic patients display differences in choice of healthcare utilization for neck pain. Non-Hispanic black patients account for 29% of all outpatient visits; 20% are treated in a hospital outpatient clinic and 9% are treated in the physician office setting. In contrast, although Hispanic patients utilize outpatient settings to a similar degree (32%), 14% receive treatment in a hospital outpatient setting and 18% receive treatment in a physician’s office. When evaluating total healthcare visits for neck pain, non-Hispanic white patients account for most of the visits (57%), followed by Hispanic and non-Hispanic black patients (14%; 8%). (Reference Table 2A.3.3 PDF CSV)

When adjusted for the US 2013 Census population, estimates for hospital discharges for cervical disorders are similar throughout the four US regions analyzed, but were highest in the South region for emergency department visits (3% of all visits for any diagnoses) and in the West region for outpatient visits (2.7%) and physician office visits (2.3%). Overall, healthcare visits for cervical disorders are highest in the western United States, representing 2.1% of visits for any diagnoses. (Reference Table 2A.3.4 PDF CSV)



Length of Stay

Persons hospitalized for neck pain in 2013 spent an average of 4.6 days in the hospital. Those hospitalized for neck injuries had the longest stay, on average 7.2 days. When comparing total days of hospitalization for all causes with those for neck pain, the average length of stay is similar. Overall, hospitatl stays for neck pain constituted 2% of both discharges and total hospital days in 2013. The length of hospital stays has remained relatively stable since 2004. (Reference Table 2A.8 PDF CSV and Table 2A.9 PDF CSV)

Although females are likely to have slightly shorter hospital stays for all causes of neck pain, it is only for neck injuries that a significant difference is seen: 8.0 days for males versus 6.2 days for females. (Reference Table 2A.10.1 PDF CSV)

Age is a greater factor in length of stay than gender. Although persons younger than 18 years of age constitute a small proportion of back pain hospitalizations, they have, on average, a stay that is 1.62 times longer than the average length of stay for persons in this age group for all causes. Hospital stays for neck pain are consistent between ages 18 to 64 years at 4.2 days, increasing to 5.1 days in the 65 years and older age group. (Reference Table 2A.10.2 PDF CSV)

Average length of stay for non-Hispanic white patients for all cervical/neck pain is 4.4 days compared with 5.2 days for non-Hispanic black, non-Hispanic other, and Hispanic patients. The length of stay for neck injuries is longer by a day or more for non-Hispanic black, non-Hispanic other, and Hispanic patients compared with non-Hispanic white patients (6.9 to ≥ 8.0) . There is no significant difference in length of stay among geographic regions. The southern region of the United States reports the highest number of discharges and total hospital days for all causes, but this region also has a larger share of the population. (Reference Table 2A.10.3 PDF CSV and Table 2A.10.4 PDF CSV)


Hospital Charges

Average hospital charges are provided along with length of stay in the HCUP NIS database. Hospital charges are not what is actally paid, but the initial charges from the hospital, which provide a measure for comparison purposes. On average, hospital charges for a neck pain inpatient visit were 148% that of the average inpatient visit for any cause. In 2013, an estimated $36 million in charges were assessed against the 614,200 inpatient stays for neck pain, 3% of the estimated total $1.4 billion in hospital charges for that year. Mean charges of $97,400 were highest for neck injuries and, at $52,900, lowest for neck disorders. (Reference Table 2A.9 PDF CSV)

In patients with neck pain, the 45-64 and 65 years and older age groups collectively represent 81.8% of the total hospital charges among the population. Of note, the ratio of mean charges for cervical/neck pain to all hospital charges is highest in ages 18 years and younger (3.24), decreasing as the population ages. No considerable differences are reported between males and females in relation to hospital charges. (Reference Table 2A.10.1 PDF CSV and Table 2A.10.2 PDF CSV)

Hispanic patients show the largest ratio of mean hospital charges for neck pain-related visits to total hospital visits, at 1.91. This is in comparison to the ratio of 1.53 and 1.42 for non-Hispanic blacks and non-Hispanic whites, respectively. Non-Hispanic white patients account for 73.2% of total spending for neck pain visits, primarily because they compose a larger share of the total population. (Reference Table 2A.10.3 PDF CSV)

There is only a slight variation among geographic regions with regard to the ratio of hospital charges for neck pain visits to total hospital visit charges, with the West region of the US displaying the largest ratio of 1.57 based on mean charges per visit of $81,200. The northeastern United States has the smallest ratio,1.36, indicating charges were closer to the overall US average. The Midwest region had the lowest mean charges per visit. Reference Table 2A.10.4 PDF CSV)


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