Healthcare disparities in adolescent idiopathic scoliosis: the impact of socioeconomic factors on Cobb angle

Study designRetrospective chart review.ObjectivesThe 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. Summary of background dataEarly 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.MethodsData 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 chi (2) analysis were used to determine the significant differences and correlations. ResultsFemale patients (n=326, CA=22.4 degrees) had significantly greater Cobb angle measurements compared with male patients (n=117, CA=18.1 degrees). Patients with government-supported insurance had significantly higher Cobb angles (CA=22.1 degrees) than privately insured patients (CA=19.2 degrees) 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 chi (2) analysis showed no association between Cobb angle and race.ConclusionsCobb angle severity was not influenced by SES factors, including ethnicity and household income.Level of evidenceLevel-II.