Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Children's Hospital New Orleans, LSU Health Science Center, New Orleans.
J Pediatr Orthop. 2022 Sep 1;42(8):427-431. doi: 10.1097/BPO.0000000000002213. Epub 2022 Jul 19.
Adolescent idiopathic scoliosis (AIS) has evidence-based, nonoperative treatments proven to be effective with early diagnosis and prompt treatment. The purpose of this study was to identify potential disparities in access to nonoperative treatment for AIS. Specifically, we sought to determine the interaction of socioeconomic factors on a major curve magnitude and recommend treatment at the initial presentation.
A retrospective review of AIS patients who underwent surgery at a single tertiary pediatric hospital between January 1, 2013 and December 31, 2018 was conducted. Patients were divided into 2 groups for comparison: patients with public insurance (PUB) and those with private insurance (PRV). Primary variables analyzed were patient race, Area Deprivation Index (ADI), major curve magnitude, and treatment recommendation at the initial presentation. Univariate and multivariate analyses were conducted to identify the predictors of the major curve magnitude at presentation.
A total of 341 patients met the inclusion criteria; PUB and PRV groups consisted of 182 (53.4%) and 159 (46.6%) children, respectively. Overall, the major curve magnitude at presentation was significantly higher in PUB compared with PRV patients (50.0° vs. 45.1°; P =0.004) and higher in Black patients compared to White patients (51.8 vs. 47.0, P =0.042). Surgery was recommended for 49.7% of the PUB group and 43.7% of the PRV group. A lesser number of PUB patients had curve magnitudes within the range of brace indications (≤40°) compared to PRV patients (22.5% vs. 35.2%, respectively; P =0.010). The odds of having an initial major curve magnitude <40 degrees were 67% lower among Black patients with public insurance compared to Black patients with private insurance (OR=0.33; 95% CI: 0.13-0.83; P =0.019).
This study demonstrated disparity in access to nonoperative treatment for pediatric scoliosis. Black patients with public insurance were the most at-risk to present with curve magnitudes exceeding brace indications. Future work focused on understanding the reasons for this significant disparity may help to promote more equitable access to effective nonoperative treatment for adolescent idiopathic scoliosis.
III.
青少年特发性脊柱侧凸（AIS）有循证的非手术治疗方法，早期诊断和及时治疗效果显著。本研究的目的是确定 AIS 非手术治疗机会的潜在差异。具体而言，我们试图确定社会经济因素对主要曲线幅度的相互作用，并在初次就诊时建议治疗。
对 2013 年 1 月 1 日至 2018 年 12 月 31 日在一家单中心儿科医院接受手术的 AIS 患者进行了回顾性研究。患者分为两组进行比较：有公共保险（PUB）和有私人保险（PRV）的患者。主要分析变量为患者种族、区域贫困指数（ADI）、主要曲线幅度和初始就诊时的治疗建议。进行了单变量和多变量分析以确定就诊时主要曲线幅度的预测因素。
共有 341 名患者符合纳入标准；PUB 和 PRV 组分别包括 182 名（53.4%）和 159 名（46.6%）儿童。总体而言，PUB 组患者就诊时的主要曲线幅度明显高于 PRV 组（50.0°比 45.1°；P=0.004），黑人患者高于白人患者（51.8°比 47.0°；P=0.042）。PUB 组有 49.7%的患者推荐手术，PRV 组有 43.7%的患者推荐手术。与 PRV 患者相比，PUB 患者的曲线幅度在支具适应证范围内（≤40°）的比例较低（分别为 22.5%和 35.2%；P=0.010）。与私人保险的黑人患者相比，公共保险的黑人患者初次就诊时主要曲线幅度<40 度的可能性低 67%（比值比=0.33；95%置信区间：0.13-0.83；P=0.019）。
本研究表明，儿童脊柱侧凸非手术治疗机会存在差异。有公共保险的黑人患者最有可能出现超过支具适应证的曲线幅度。未来的研究工作集中于了解这种显著差异的原因，可能有助于促进青少年特发性脊柱侧凸更公平地获得有效的非手术治疗。
III。
