Adolescent Idiopathic Scoliosis Care in an Underserved Inner-City Population: Screening, Bracing, and Patient- and Parent-Reported Outcomes

Diebo, Bassel G.; Segreto, Frank A.; Solow, Maximillian; Messina, James C.; Paltoo, Karen; Burekhovich, Steven A.; Bloom, Lee; Cautela, Frank S.; Shah, Neil V.; Passias, Peter G.; Schwab, Frank J.; Pasha, Saba; Lafage, Virginie; Paulino, Carl B.

doi:10.1016/j.jspd.2018.11.014

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Among this inner-city scoliosis population, 21.3% of adolescents were never screened for scoliosis, nearly half had no prior knowledge of AIS, and nearly 3 in 5 of screened patients did not initiate bracing therapy despite Scoliosis Research Society recommendations. 29 Diebo and colleagues acknowledged that a large proportion of patients from underserved populations presented with a history of inadequate scoliosis care. However, the association between neighborhood deprivation and scoliosis severity was not assessed and thus it is difficult to characterize how these reported disparities in inner-city scoliosis care affect curve progression.…”

Section: Discussionmentioning

confidence: 99%

“…In a survey of 47 adolescents from an underserved inner-city population in New York presenting for a primary AIS visit, Diebo and colleagues reported that 15 patients qualified for observation based on curve magnitude and 32 qualified for either bracing or surgical treatment. Among this inner-city scoliosis population, 21.3% of adolescents were never screened for scoliosis, nearly half had no prior knowledge of AIS, and nearly 3 in 5 of screened patients did not initiate bracing therapy despite Scoliosis Research Society recommendations 29. Diebo and colleagues acknowledged that a large proportion of patients from underserved populations presented with a history of inadequate scoliosis care.…”

Section: Discussionmentioning

confidence: 99%

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Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts

Nezwek

Braun

Menendez

et al. 2021

Journal of Pediatric Orthopaedics

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Background: There is growing interest in identifying predictors of large scoliosis curves at initial presentation, but few data to guide such preventive efforts. The association of neighborhood socioeconomic deprivation with curve magnitude in this context has not been previously evaluated. The purpose of our study was to determine the correlation of socioeconomic deprivation with scoliosis curve magnitude at initial presentation. Secondarily, we assessed the correlation of body mass index (BMI) with curve severity. Methods: We retrospectively identified 202 patients presenting with adolescent idiopathic scoliosis to a single tertiary care center in Massachusetts from January 2015 to August 2018. The Area Deprivation Index (ADI), a validated composite measure of neighborhood socioeconomic deprivation, was calculated for each patient. Curve magnitude, age, sex, BMI, race, and insurance status were recorded. Pearson correlation was used to determine the association of the ADI and BMI with scoliosis severity.Results: There was no correlation between the ADI and the magnitude of scoliosis at presentation (r = 0.055; P = 0.43). Greater BMI was moderately correlated with increased scoliosis curve magnitude (r = 0.28; P < 0.001). There was no association between curve magnitude and patient age, sex, race, or insurance status. Conclusions: The finding that neighborhood socioeconomic deprivation did not correlate with greater scoliosis severity at presentation may be suggestive of equitable access to specialized scoliosis care. Future research should determine whether this reassuring finding is unique to Massachusetts--a state with high rates of health insurance coverage--or generalizable to other US states. In addition, our study further corroborates the notion that greater BMI is associated with larger scoliosis curves, and calls for targeted interventions to facilitate early scoliosis detection in the growing childhood obese population. Level of Evidence: Level II-prognostic study and retrospective study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts

Nezwek

Braun

Menendez

et al. 2021

Journal of Pediatric Orthopaedics

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“…Kelainan bentuk biasanya berkembang dengan pertumbuhan tulang belakang yang cepat dan dapat mempengaruhi kualitas hidup individu yang berhubungan dengan kesehatan [2]. Lengkungan skoliosis akan bertambah besar karena bertambahnya usia terutama pada masa pertumbuhan [3].…”

Section: Pendahuluanunclassified

Kemaknaan Lengkung Kurvatura dan Rib Hump pada Skrining Risiko Skoliosis

Syabariyah¹,

Anesti²,

Alfin³

2022

BIKK

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ndikator klinis pada skoliosis khususnya pada remaja (misalnya kelengkungan lateral; tulang rusuk (rib hump), pinggul dan asimetris bahu) biasanya muncul di awal masa remaja dan dapat menyebabkan deformitas fisik, penurunan harga diri rendah, tingkat depresi yang lebih tinggi dan kompromi paru. Kajian ini menjelaskan subjek skrining skoliosis di sekolah. Fokus kajian adalah dengan tinjauan literatur kemaknaan lengkung kurvatura dan rib hump pada pemeriksaan skrining risiko skoliosis di sekolah. Metode yang digunakan dalam penelitian ini menggunakan desain penelitian tinjauan literatur. Data yang digunakan adalah data sekunder berupa artikel yang relevan dari Scopus, PubMed, Science Direct, CINAHL, ProQuest dan Garuda. Dengan pelaksanaan skrining skoliosis terutama pada usia remaja adalah untuk menurunkan dan menghentikan progresifitas kurvatura skoliosis pada tulang belakang di usia pertumbuhan sebelum maturitas skeletal terbentuk sempurna, dengan harapan melalui deteksi dini dapat mempercepat penetapan diagnosis skoliosis sehingga tatalaksana yang sesuai dapat segera diberikan.

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“…19,20 Most of the current literature surrounding health care disparities in AIS focuses on the effect of SES, insurance type, race/ethnicity, and obesity on major coronal curve magnitude and access to and delivery of nonoperative treatment. 2,8,12,16,17,21 However, although obesity has been correlated with larger curves at initial presentation, 16,17 mixed conclusions regarding the effects of SES, race, and insurance on AIS care and curve magnitude exist. 2,8,12,13,17 At-risk patients in disadvantaged inner-city neighborhoods where in-school screenings are not statemandated are potentially vulnerable to poorer nonoperative scoliosis health care access as they may experience delayed initial referral and missed nonoperative treatments.…”

mentioning

confidence: 99%

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

Thornley,

Garner,

Rogers

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery. Methods: A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant. Results: The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients (P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions (P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions (P < 0.001, P = 0.050) and decreased rates of obtaining second opinions (P = 0.004, P = 0.001). Conclusion: Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care. Level of Evidence: Level III; retrospective case-control study.

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Adolescent Idiopathic Scoliosis Care in an Underserved Inner-City Population: Screening, Bracing, and Patient- and Parent-Reported Outcomes

Cited by 12 publications

References 28 publications

Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts

Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts

Kemaknaan Lengkung Kurvatura dan Rib Hump pada Skrining Risiko Skoliosis

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

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