O1043: Do All Patients Have Equal Access to Nonoperative Treatment for Pediatric Scoliosis?

Background: 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 major curve magnitude and recommended treatment at initial presentation.

Methods: 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 initial presentation. Univariate and multivariate analysis were conducted to identify the predictors of major curve magnitude at presentation.

Results: A total of 341 patients met 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 to 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. Less 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 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: Disparity exists regarding access to nonoperative treatments for pediatric scoliosis with publicly insured Black patients most at-risk in our cohort. Future work focused on understanding underlying reasons for this significant disparity may help to promote more equitable access to effective nonoperative treatment for adolescent idiopathic scoliosis.