Do All Patients Have Equal Access to Nonoperative Treatment for Pediatric Scoliosis?

Background: The purpose of this study was to determine the interaction of socioeconomic factors on healthcare disparities in access to treatment for adolescent idiopathic scoliosis (AIS) based on curve magnitude and recommended treatment at initial presentation.

Methods: This was a retrospective review of surgical AIS patients at a tertiary pediatric hospital. Patients were divided into 2 groups for primary comparison: patients with public insurance (PUB) and those with private insurance (PRV). Variables analyzed included Cobb magnitude, race, Area Deprivation Index (ADI), BMI, and treatment recommendation at initial presentation.

Results: A total of 341 patients met inclusion criteria including 182 (53.4%) PUB and 159 (46.6%) PRV. Cobb angle at presentation was higher in PUB compared to PRV patients (50.0° vs. 45.1°; p = 0.004) and higher in Black compared to White patients (51.8 vs 47.0, p = 0.042). Surgery was the initial recommendation for 49.7% of the PUB group and 43.7% of the PRV group. 35% of PRV had Cobb angles considered appropriate for bracing ( <40 degrees) compared to only 22% of PUB (p=0.010). Further analysis revealed no difference in bracing potential amongst White patients regardless of insurance status (35% PRV vs 33% PUB, p = 0.80), but substantial discrepancy amongst Black patients (37% PRV vs 16% PUB, p = 0.016). The odds of having an initial Cobb angle less than 40 degrees were 67% lower amongst Black patients with public insurance compared to Black patients with private insurance (OR = 0.33; 95% CI: 0.13 - 0.83; p = 0.019).

Conclusion: The findings of this study suggest a drastic disparity in access to nonoperative treatment for AIS amongst Black patients with public insurance compared to all other patients in this study cohort. Future work focused on understanding the underlying reasons for this inequality will be important when creating efforts to reduce gaps in early detection and access to nonoperative care.