A New Look on the Epidemiology of Slipped Capital Femoral Epiphysis: A Topic Revisited

Abstract

Background: Slipped capital femoral epiphysis (SCFE) is a common hip pathology affecting adolescents mostly in the rapid growth phase. Previous studies have presented epidemiological data to inform practitioners on its etiology to improve diagnosis, treatment, and prevention. However, in recent years national databases have been redesigned, which may change previously published information on SCFEs. The purpose of this study is to evaluate SCFE epidemiology using the 2019 Kids' Inpatient Database (KID) and HCUPnet, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, in conjunction with U.S. Census Data.Methods: The Kids' Inpatient Database (KID) reflects data on 5.9 million pediatric discharges in 2019 and was combined with U.S. Census data to produce epidemiologic data regarding SCFEs in the pediatric population. KID regional data was then overlayed with National Oceanographic and Atmospheric Administration (NOAA) data to assess the associations between climate patterns and UV indices with SCFE incidence.Results: Overall incidence of SCFE in the U.S. was 2.66/100,000 children 9-16 years of age. The average age at presentation with SCFE was 12.3 years with males being older at presentation (12.8 vs. 11.6 years; P<.001; r=0.34). Males were significantly more likely to develop a SCFE than females (OR 1.73; 95% CI, 1.51-1.97). Black patients were significantly more likely to present with a SCFE than all other races (OR 1.66; 95% CI, 1.40-2.97). Obesity (23.2%) was the most common metabolic and endocrine comorbidity followed by severe obesity (7.5%). Geographical regions with colder temperatures and lower UV indexes had higher SCFE rates, while regions with higher temperatures and higher UV indexes had lower SCFE rates.Conclusion: This study determined a lower SCFE incidence rate than previously reported but shows similar distributions of SCFEs amongst different races. Age of onset was increased compared to previous studies. The rate of obesity also continues to increase while the incidence of SCFEs has experienced a gradual decrease over time. It is plausible that environmental factors and race (skin tone) may have a more influential effect on the development of this pathology.Level of Evidence: III - Cross-sectional study of non-consecutive patientsKey Concepts•SCFE incidence rates are lower than previously reported.•Obesity continues to increase while SCFEs have remained stable.•Cold climate regions (with lower UV-indexes) may be a risk factor for SCFEs, while areas with hot climate regions (with higher UV-indexes) could be protective.