Lower socioeconomic status is not associated with severity of adolescent idiopathic scoliosis: a matched cohort analysis.

Abstract

Assessing the influence of socioeconomic status (SES) on the severity of adolescent idiopathic scoliosis (AIS) on initial presentation to the spinal surgeon remains a challenge. The area deprivation index (ADI) is a validated measure of SES that abstracts multiple domains of disadvantage into a single score. We hypothesized that patients with low SES (high ADI) present to the orthopedic clinic with more advanced curve pathology. We retrospectively reviewed patients diagnosed with AIS. Subjects were assigned ADI scores based on Zip codes. Matched cohorts of high and low ADI were generated using propensity scores. Bivariate and multivariate analyses were performed to identify factors impacting the magnitude of the curve at presentation. A total of 425 patients with appropriate imaging were included. After matching, the study population was 69.2% female and 92.3% Black. The mean BMI percentile was 61.9. Medicaid covered 57.3% of subjects, and 42.7% had commercial insurance. The mean ADI was 55.5. The mean Cobb angle at presentation was 33.6 degrees. Cobb angle was significantly greater among female patients (36.0 degrees vs 28.0) and among patients with greater BMI percentile (β = 0.127), but was not significantly associated with ADI, race, or insurance type. ADI was not associated with the rate of surgery. ADI is not predictive of curve severity in pediatric patients presenting to the clinic for AIS. Female sex and BMI are independently associated with advanced curvature. Public health workers, primary care providers, and surgeons should remain aware of the complex interactions of socioeconomic factors, BMI and sex when addressing barriers to timely care. Prognostic Level III.