Abstract
BackgroundHip screening is the standard approach for the early detection of developmental dysplasia of the hip (DDH). However, there is a lack of evidence regarding the effects of national policy on early diagnosis and later surgical incidence. The purpose of this national study is to estimate DDH incidence in the Taiwanese population through a new diagnosis definition and to examine whether a health promotion policy could reduce surgeries for DDH.Methods and resultsSix birth-year cohorts (2000–2005) were evaluated for DDH diagnosis and related surgeries using the database of the National Health Insurance Administration, which covers 99% of the population of Taiwan. Children with three or more sequential International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (754.3x) in the outpatient claim file or DDH-related surgeries were studied. The outcome of hip screening was evaluated with the ratio of early diagnosis (0–6 months) to late diagnosis (1–5 years) and the incidence of major surgeries for DDH. DDH incidence was 1.54 per thousand live births (2,255/1,462,539). After a hip screening promotion policy was implemented in 2002, ratios of early/late diagnosis increased from 1.06, 1.25, 1.38, and 1.5 to 1.75 for the years 2000 to 2005, respectively. Incidences of major surgery decreased from 0.41–0.47 per thousand before policy administration to 0.33–0.37 per thousand after policy administration.DiscussionThe DDH incidence of 1.54 per 1,000 in a geographically well-defined area offered epidemiological data for further studies in Asian populations. The results suggest that the health promotion policy is associated with an increase in early diagnosis and subsequently a decrease in surgeries for DDH.
Highlights
Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in infants
The results suggest that the health promotion policy is associated with an increase in early diagnosis and subsequently a decrease in surgeries for developmental dysplasia of the hip (DDH)
This study reviewed DDH-related data in the National Health Insurance (NHI) databank to answer the following questions: (1) Can incidence of DDH be estimated from national medical insurance data? (2) Does health policy increase early detection rate of DDH? (3) Does early detection result in a decrease of surgeries for DDH, especially major surgeries?
Summary
Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in infants. Late DDH diagnosis requires operations for profound dysplasia and dislocation of the hip [3]. Evidence suggests that treatment for late-diagnosed DDH is unlikely to result in a normal hip, with this disease still leading to early degeneration and a long-term burden to the health care system. There is a lack of evidence regarding the effects of national policy on early diagnosis and later surgical incidence.
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