Barriers to early detection: the impact of healthcare access and screening on conservative treatment opportunities in adolescent idiopathic scoliosis.

INTRODUCTION: Prior to surgical intervention for adolescent idiopathic scoliosis (AIS), patients with mild-to-moderate deformity and skeletal growth remaining can be treated conservatively after referral to specialists. Healthcare access may influence screening opportunities and time-to-referral and, therefore, the potential for conservative treatment. This study aimed to assess whether specific social determinants of health (SDOH) and access to care predispose patients to late presentation. METHODS: AIS patients over a 2-year period at a single institution were retrospectively reviewed, assessing the association between SDOH (race/ethnicity, ADI, COI, insurance, distance to institution, and PCP affiliation) and the odds of presenting with surgical indications (> 50°). Secondary aims assessed associations between SDOH and initial treatment type and referral-to-appointment time. Generalized linear models were used with the odds ratio (OR) or geometric mean ratio (GMR) reported. RESULTS: 279 patients with mean age 13.5 years and 72% female were included. No SDOH were associated with increased odds of a > 50° curve at presentation. However, patients with an institution-affiliated well-child visit had higher odds of observation vs. surgery compared to patients with a non-affiliated visit (OR 2.28, 95% CI 1.06-4.90, P = 0.035). A 10-mile increase in distance from our institution was associated with a 2.9% increase in time from referral to appointment (GMR per 10 miles 1.03, 95% CI 1.01-1.05, P = 0.009). DISCUSSION: Several factors related to healthcare access influenced initial treatment and referral delays, such as referrals from non-affiliated PCPs and patients from further away had delayed presentation. These findings emphasize potential barriers to healthcare access, including poor screening and delayed referrals, both which may cause patients to initially present with more severe scoliosis.

Duke Scholars

Author Robert Lark Orthopaedic Surgery

Author Cynthia Lea Green Biostatistics & Bioinformatics, Division of Biostatistics

Author Anthony Agostino Catanzano Jr. Orthopaedic Surgery