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Topic:

Adolescent Idiopathic Scoliosis

Issue:

Spine

Category:

Developmental

Title:

Impact of Social Determinants of Health on Adolescent Idiopathic Scoliosis Curve Severity

Author:

Orellana, Kevin J. BS; Lee, Julianna BA; Yang, Daniel MS; Hauth, Lucas BS; Flynn, John M. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e168-e173, DOI: 10.1097/BPO.0000000000002529

Level Of Evidence:

III

# of Patients:

180

Study Type:

Retrospective Comparative Study

Location:

Single institution

Summary:

The study investigates the influence of social determinants of health (SDH), specifically socioeconomic status (SES) and insurance type, on the severity of adolescent idiopathic scoliosis (AIS) at the time of presentation and surgery. It aims to analyze the correlation between SDH factors and the progression of scoliosis curves.

Methods:

A retrospective review was performed on consecutive patients undergoing posterior spinal fusion for AIS. Data on insurance status (private vs. public) and childhood opportunity index (COI) categories (LOW vs. HIGH) were collected. Initial and preoperative curve magnitudes were compared, and univariate and multivariate analyses were performed to evaluate differences between subgroups.

Exclusions:

Patients without complete data or who did not undergo surgery during the study period were excluded from the analysis.

Results:

Race and Insurance Type: Statistically significant differences in race and insurance types were observed between the LOW COI and HIGH COI groups, with the LOW COI group having more underrepresented minority and publicly insured patients (P < 0.001). Curve Severity: Patients in the LOW COI group presented with more severe curves, both at initial presentation (6 degrees more severe) and preoperatively (4 degrees more severe), compared to the HIGH COI group (P = 0.009 and P = 0.015, respectively). Bracing Range: Only 13% of patients in the LOW COI group presented with curves within the bracing threshold, compared to 31% in the HIGH COI group (P = 0.009).

Conclusions:

Socioeconomic status significantly influences the severity of AIS, with patients from lower SES backgrounds presenting with more severe curves at the time of surgery, which may limit the effectiveness of nonsurgical treatments. Addressing social inequalities could help optimize outcomes for AIS patients.

Relevance:

Limitations:

Perspective:

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