INTRODUCTION Previous studies have shown racial/ethnic disparities in outcomes for patients with cancer, but there is limited data for patients with spinal metastases. METHODS The United States National Inpatient Sample database (2012-2014) was queried to identify patients with metastatic spine disease and cord compression (MSCC) or pathological fracture. Clinical presentation, type of intervention, and in-hospital outcomes were compared between races/ethnicities. Multivariate logistic regression analyses were performed and adjusted for differences in patient age, insurance status, income quartile, hospital teaching status, Charlson comorbidity index, smoking status, tumor type, and neurological status. RESULTS A total of 47,390 patients were identified - 73.5% Caucasian, 15.2% African-American, 8.0% Hispanic, and 3.3% Asian. Approximately one-third (36.2%) of patients presented with MSCC. AAs had a 78% higher chance of presenting with MSCC compared to Caucasians (OR 1.78; 95% CI, 1.59-2.00; P < .001) and an 89% higher chance of presenting with paralysis (OR 1.89; 95% CI, 1.59-2.25; P < .001). On adjusted analyses they were less likely to undergo surgical intervention (OR 0.68; 95% CI, 0.54-0.85; P = .001), significantly more likely to experience a complication (OR 1.37; 95% CI, 1.13-1.66; P = .001), and significantly more likely to experience prolonged length of stay (OR 1.24; 95% CI, 1.01-1.52; P = .035) when compared to Caucasians. CONCLUSION African-American patients with metastatic spine disease are at a disadvantage compared to Caucasians, with significantly higher rates of MSCC and paralysis, lower rates of surgical intervention, and higher rates of complications and prolonged length of stay.