Sociodemographic Factors Associated with Late-Stage Presentation of Adolescent Idiopathic Scoliosis

Abstract

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is a common referral to pediatric orthopedic surgeons. Timely treatment with appropriate bracing decreases the risk of curve progression and need for surgical intervention. Despite pediatrician screening, patients still present to orthopaedic surgeons with curve magnitudes too significant for appropriate nonoperative bracing. METHODS: This retrospective cross-sectional study included patients 10 to 18-years-old diagnosed with AIS between 2011 and 2021 at a major metropolitan tertiary care center. Patients were excluded if initial radiographs were obtained more than one week after clinical diagnosis. Scoliosis severity was classified based on initial radiographs. Sociodemographic factors were recorded including patient address, which was cross-referenced with the diversitydatakids.org Child Opportunity Index (COI) database (which analyzes quality of resources in a geographic area). RESULTS: Sociodemographic factors, especially race, health insurance status, and lower resourced addresses, are significantly associated with late-stage presentation of scoliosis in a major metropolitan city (Fig. 1). The percentage of self-identified black patients with severe scoliosis (40%) was twice that of any other race (20%). Similarly, the percentage of patients from very low resourced areas with severe scoliosis (31%) was nearly double that of patients from very high resourced areas (16%). Nearly 25% of patients with public health insurance presented with severe scoliosis, 5% more than patients with private health insurance.CONCLUSION: Early identification of scoliosis and timely referral to pediatric orthopedic surgeons requires public health initiatives to educate primary care providers, pediatricians, and scoliosis screeners and address access to care in geographic areas with known low COI scores.