Socioeconomic Risk Factors for Poor Outcomes of Developmental Dysplasia of the Hip

Abstract

To examine the relationship between socioeconomic factors and outcomes of developmental dysplasia of the hip (DDH). A retrospective review of patients with DDH at a tertiary pediatric hospital from 2003 to 2012 with 2years minimum follow-up was conducted. The relationship between socioeconomic factors with late presentation, treatment, and outcomes was examined. Socioeconomic factors included insurance status, language, and ethnicity. In total, 188 patients met criteria. Patients with late presentations were more likely to be Hispanic (P=.02). However, public insurance and a non-English language were not associated with late presentation. Hispanic patients (P=.01) and patients with a non-English language (P=.01) had a lower nonoperative treatment success rate. Hispanic patients had more surgical procedures performed than non-Hispanic patients (P=.04). Patients with range of motion limitations were more likely to have public insurance (P=.05) and be Hispanic (P=.04). On multiple logistic regression analysis controlling for late presentation, patients with public insurance had increased odds of range of motion limitations (OR 2.22, P=.04). Patients with public insurance (OR 0.44, P=.04), a non-English primary language (OR 0.30, P<.01), and Hispanic ethnicity (OR 0.37, P=.01) had decreased odds of successful nonoperative treatment. Public insurance, a non-English language, and Hispanic ethnicity are risk factors for inferior outcomes for DDH. When controlling for late presentation, these were significant risk factors for nonoperative treatment failure.