Torres-Gonzalez Luis, Morgan Sara J, Seaver Christopher D, Cady Rhonda G, Brown Zelphia C, Williams Maykala J, Miller Daniel J
Research Department, Gillette Children's Specialty Healthcare, 200 University Avenue East, St. Paul, MN, 55101, USA.
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
Spine Deform. 2026 Jan;14(1):205-214. doi: 10.1007/s43390-025-01198-6. Epub 2025 Oct 17.
To assess potential disparities in care for non-ambulatory children with cerebral palsy (CP) and associated neuromuscular scoliosis treated at a quaternary pediatric hospital.
This retrospective cohort study included non-ambulatory children CP who received spinal deformity surgery between 01/2012 and 12/2022. Demographic, clinical, and radiographic data were collected. Relationships between demographic factors and clinical/radiographic data were assessed using Fisher's Exact Test, Wilcoxon Rank-Sum test, Kruskal-Wallis one-way ANOVA, and linear regression models.
Of 502 children identified, 328 met eligibility criteria. The mean age of the sample was 9.8 ± 4.0 years, 59% were male. On presentation, the average major coronal curve magnitude was 46 ± 23˚. Most (70%) were White, 13% were Black, 6% were Hispanic or Latino, and the remaining participants were Asian, Pacific Islander, Native American, Alaska Native, or declined to answer. Most spoke English (89%). Just under half (45%) had both government and commercial insurance and 24% had only government insurance. Black compared to White race (p = .03), government compared to commercial insurance (p = .02), and farther distance from hospital (p < .001) were associated with larger curve magnitudes at presentation, after adjustment for covariates. Non-English language (p = .002) was associated with longer time from surgical recommendation to surgery, after adjustment for covariates.
Health disparities were identified related to ethnicity, race, preferred language, and geographical distance from the hospital for children with CP and neuromuscular scoliosis. These findings highlight the need for development of standardized criteria for surveillance, imaging, and referral to reduce health disparities for this specific population.
评估在一家四级儿科医院接受治疗的非行走型脑瘫（CP）及相关神经肌肉型脊柱侧凸患儿在医疗护理方面可能存在的差异。
这项回顾性队列研究纳入了2012年1月至2022年12月期间接受脊柱畸形手术的非行走型脑瘫患儿。收集了人口统计学、临床和影像学数据。使用Fisher精确检验、Wilcoxon秩和检验、Kruskal-Wallis单因素方差分析和线性回归模型评估人口统计学因素与临床/影像学数据之间的关系。
在确定的502名儿童中，328名符合入选标准。样本的平均年龄为9.8±4.0岁，59%为男性。就诊时，平均主冠状面弯曲度数为46±23°。大多数（70%）为白人，13%为黑人，6%为西班牙裔或拉丁裔，其余参与者为亚洲人、太平洋岛民、美洲原住民、阿拉斯加原住民或拒绝回答。大多数人说英语（89%）。略低于一半（45%）的人同时拥有政府保险和商业保险，24%的人仅拥有政府保险。在调整协变量后，与白人相比，黑人（p = 0.03）、与商业保险相比，政府保险（p = 0.02）以及距离医院较远（p < 0.001）与就诊时更大的弯曲度数相关。在调整协变量后，非英语（p = 0.002）与从手术建议到手术的时间较长相关。
已确定脑瘫和神经肌肉型脊柱侧凸患儿在种族、民族、首选语言以及与医院的地理距离方面存在健康差异。这些发现凸显了制定标准化监测、成像和转诊标准以减少这一特定人群健康差异的必要性。
