Public Insurance Status is Associated With Lower Bracing Treatment Success in Infants With Developmental Dysplasia of the Hip.

BACKGROUND

Early diagnosis and initiation of bracing for developmental dysplasia of the hip (DDH) can result in disease resolution. Bracing failure or late presentation necessitates surgical intervention. Socioeconomic factors can contribute to delayed diagnosis requiring more invasive treatment. Our purpose was to evaluate whether measures of health disparities are associated with bracing outcomes and treatment progression in children with DDH.

METHODS

Patients screened for DDH in a pediatric orthopaedic clinic at a single academic children's hospital between January 2013 and December 2021 were retrospectively reviewed. Demographics, state Area Deprivation Index (ADI; decile from 1 to 10 with a higher number indicating greater socioeconomic disadvantage), distance from a primary residence to the clinic, insurance type, >1 no-show appointments, and treatment course were collected.

RESULTS

Four hundred one patients received a diagnosis of DDH and were included in the analysis. The median age at presentation was 46 days and the median state ADI was 4. Two hundred ninety-six patients (73.8%) had resolution of DDH with bracing (Pavlik harness, abduction brace, or both), 77 (19.2%) underwent surgery, and 28 (7.0%) were lost to follow-up. Compared with patients with ADI 1 to 4, patients with ADI 5 to 10 were significantly more likely to have public insurance ( P <0.001) and >1 no-show appointment ( P <0.001). Higher socioeconomic disadvantage was associated with a greater proportion of patients requiring treatment progression (ie, failed bracing and need for surgery) or loss to follow-up ( P <0.001). Regressions controlling for sex, race, state ADI, distance from residence to clinic, and insurance type revealed that public insurance was predictive of age >6 months at presentation ( P <0.001), greater treatment progression ( P <0.001), and higher need for surgery ( P =0.001). Public insurance was a negative predictor of successful bracing treatment ( P <0.001).

CONCLUSION

Our study showed that children with DDH and public insurance were older at initial presentation and had a higher likelihood of bracing failure necessitating more invasive treatment. Public insurance may be the most significant measure of health disparities in assessing which DDH patients are at risk for conservative treatment failure and would benefit from early social work support.

LEVEL OF EVIDENCE

Level III-therapeutic.