Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States of America.
Department of Orthopedics, Cook Children's Medical Center, Fort Worth, Texas, United States of America.
PLoS One. 2022 Jun 24;17(6):e0269745. doi: 10.1371/journal.pone.0269745. eCollection 2022.
Slipped Capital Femoral Epiphysis (SCFE) is a skeletal pathology affecting adolescents which requires timely surgery to prevent progression. Delays in diagnosis and treatment of SCFE can negatively affect patient prognosis, and few studies have examined how health disparities and barriers to care may influence these delays. In particular, only a handful of studies have included a Hispanic patient sample, despite this ethnic group's increased risk for the disease and unique barriers to care. A retrospective chart review was conducted for 124 patients surgically treated for idiopathic SCFE from January 2010 to September 2017. Patient data included age, facility and date of diagnosis, sex, BMI, race and ethnicity, Southwick slip angle, and insurance type. Results indicated that patients with private insurance were more likely to present with a mild slip than patients who were insured by Medicaid or uninsured, while patients without insurance were more likely to have severe slips. Patients without insurance also had a significantly higher mean slip than patients with insurance. The relationship between insurance status and slip angle degree was significant independent of race, even though Hispanic individuals were significantly more likely to have Medicaid or be uninsured. All patients without insurance, and a majority of those with Medicaid, were diagnosed in the emergency department. Time to diagnosis and slip angle were positively correlated, which suggests that longer delays led to increase of the slip angle, consistent with previous findings. Time to diagnosis and BMI were also correlated, which may be tied to socioeconomic factors, but the possibility of weight bias should not be dismissed. These results suggest that socioeconomic status and other factors may have contributed to barriers to care which led to delays in diagnosis and thus more severe slips. Future SCFE research should include health disparities variables to better inform treatment and prognosis.
股骨头骨骺滑脱症（SCFE）是一种影响青少年的骨骼疾病，需要及时手术治疗以防止病情进展。SCFE 的诊断和治疗延误会对患者的预后产生负面影响，很少有研究探讨健康差距和医疗保健障碍如何影响这些延误。特别是，尽管西班牙裔患者群体患这种疾病的风险增加，并且存在独特的医疗保健障碍，但只有少数研究纳入了西班牙裔患者样本。
对 2010 年 1 月至 2017 年 9 月期间因特发性 SCFE 接受手术治疗的 124 名患者进行了回顾性图表审查。患者数据包括年龄、就诊机构和日期、性别、BMI、种族和民族、Southwick 滑角以及保险类型。结果表明，有私人保险的患者比有医疗补助或没有保险的患者更有可能出现轻度滑脱，而没有保险的患者更有可能出现严重滑脱。没有保险的患者的平均滑脱角度也明显高于有保险的患者。尽管西班牙裔患者更有可能拥有医疗补助或没有保险，但保险状况与滑角程度之间的关系在独立于种族的情况下具有统计学意义。所有没有保险的患者，以及大多数拥有医疗补助的患者，均在急诊科就诊。诊断时间和滑角呈正相关，这表明延迟时间越长，滑角越大，与之前的研究结果一致。诊断时间和 BMI 也呈相关，这可能与社会经济因素有关，但不能排除体重偏见的可能性。这些结果表明，社会经济地位和其他因素可能导致了医疗保健障碍，导致诊断延误，从而导致更严重的滑脱。未来的 SCFE 研究应包括健康差异变量，以更好地为治疗和预后提供信息。
