青少年特发性脊柱侧凸的医疗保健差异：社会经济因素对Cobb角的影响。
Healthcare disparities in adolescent idiopathic scoliosis: the impact of socioeconomic factors on Cobb angle.
作者信息
Russell Taylor, Dharia Anand, Folsom Ryan, Kaki Mohamad, Shumbusho Emile, Fajardo Roberto Jose, Shah Kush, Shillingford-Cole Ventrice, Hogue Grant D
机构信息
University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
出版信息
Spine Deform. 2020 Aug;8(4):605-611. doi: 10.1007/s43390-020-00097-2. Epub 2020 Mar 11.
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. 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 χ 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 χ 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.
研究设计
回顾性病历审查。
目的
本研究旨在评估在一个强制进行脊柱侧弯筛查的州，保险类型、地理社会经济地位和种族对青少年特发性脊柱侧弯（AIS）疾病严重程度的作用。青少年特发性脊柱侧弯（AIS）的早期检测与曲线进展减少、手术治疗和长期后遗症相关。保险类型、种族和社会经济地位是医疗保健可及性的重要决定因素。
方法
获取了2010年至2016年间居住在单个县、到单一医疗保健系统进行AIS初次评估且符合纳入标准的561例10至18岁AIS患者的数据。收集了包括性别、年龄、自我报告的种族、保险和邮政编码在内的人口统计学数据。结果指标包括Cobb角、曲线严重程度和转诊延迟。由一名经过专科培训的儿科骨科医生计算每个病例的初始Cobb角。邮政编码用作家庭收入水平的替代指标。采用独立样本t检验、方差分析和协方差分析以及χ分析来确定显著差异和相关性。
结果
女性患者（n = 326，Cobb角 = 22.4°）的Cobb角测量值显著高于男性患者（n = 117，Cobb角 = 18.1°）。有政府支持保险的患者的Cobb角（Cobb角 = 22.1°）显著高于有私人保险的患者（Cobb角 = 19.2°），但两者在临床上均归类于“轻度”范围，可能无临床意义。收入水平与Cobb角之间无相关性。转诊延迟和Cobb角严重程度在年龄、收入或保险方面无差异。χ分析显示Cobb角与种族之间无关联。
结论
Cobb角严重程度不受社会经济地位因素（包括种族和家庭收入）的影响。
证据级别
二级。
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