Healthcare disparities in adolescent idiopathic scoliosis: the impact of socioeconomic factors on Cobb angle
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Healthcare disparities in adolescent idiopathic scoliosis: the impact of socioeconomic factors on Cobb angle Taylor Russell1 · Anand Dharia1 · Ryan Folsom1 · Mohamad Kaki1 · Emile Shumbusho1 · Roberto Jose Fajardo1 · Kush Shah1 · Ventrice Shillingford‑Cole1 · Grant D. Hogue1 Received: 11 February 2020 / Accepted: 25 February 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective chart review. Objectives The aim of this study is to assess the role of insurance type, geographic socioeconomic status, and ethnicity in AIS disease severity in a state with mandated scoliosis screenings. Summary of background data Early detection of adolescent idiopathic scoliosis (AIS) is associated with reduced curve progression, surgical treatment, and long-term sequelae. Type of insurance, ethnicity, and socioeconomic status are important determinants in healthcare access. Methods Data were obtained for 561 AIS patients aged 10–18 years, living within a single county, and presenting to a single healthcare system for initial evaluation of AIS between 2010 and 2016 that met inclusion criteria. Demographic data including gender, age, self-reported ethnicity, insurance, and zip code were collected. Outcome measures included Cobb angle, curve severity, and referral delay. A single fellowship-trained pediatric orthopedic surgeon calculated presenting Cobb angle for each case. Zip code was used as a proxy for household income level. Independent sample t tests, analysis of variance and covariance, and χ2 analysis were used to determine the significant differences and correlations. Results Female patients (n = 326, CA = 22.4°) had significantly greater Cobb angle measurements compared with male patients (n = 117, CA = 18.1°). Patients with government-supported insurance had significantly higher Cobb angles (CA = 22.1°) than privately insured patients (CA = 19.2°) but were both classified within the “mild” range clinically, and are likely not clinically significant. There was no correlation between income level and Cobb angle. Referral delay and Cobb angle severity did not vary by age, income, or insurance. A χ2 analysis showed no association between Cobb angle and race. Conclusions Cobb angle severity was not influenced by SES factors, including ethnicity and household income. Level of evidence Level-II. Keywords Adolescent idiopathic scoliosis · AIS · Socioeconomic factors · Healthcare disparities · Cobb angle
Introduction Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine characterized by a spinal curvature greater than 10° and affects 1–2% of the general population [1, 2]. Early detection allows for conservative treatment with bracing, which has shown significant reduction in high-risk curve progression and surgical intervention [5]. Untreated or undertreated patients are at an increased risk of back pain, * Grant D. Hogue [email protected] 1
University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
pulmonary dysfunction, and need for surgical fix
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