Study: Race Among Disparities in Presentation of Adolescent Scoliosis

Black/African American adolescents were more than twice as likely as their White peers to be diagnosed with severe scoliosis in a study led by researchers at Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine. 

The retrospective cross-sectional study, published in the Journal of the Pediatric Orthopaedic Society of North America (JPOSNA), included patients aged 10-18 diagnosed with idiopathic scoliosis (curvature of the spine) in the Chicago area between 2011-21. 

Researchers, including senior author Jill Larson, MD, a Lurie Children’s pediatric orthopedic surgeon, found that race, in addition to type of insurance, gender and Child Opportunity Index factors (COI) affected whether a child referred to a pediatric orthopedic surgeons had a mild or more severe scoliosis (defined as a curve of 40 degrees or more.) The COI is a validated neighborhood-level index score derived from 29 independent indicators that are known to affect children’s health and development, such as poverty rate and access to healthy food. 

The study found the odds of presenting with severe (versus mild and moderate) scoliosis were 2.3 times higher for patients who identified as Black/African American compared to those who identified as White. Severe scoliosis was almost 40% higher in females compared to males. And lower COI scores were associated with 17-19 % higher odds of presenting with severe scoliosis.  

“Disparities in pediatric healthcare are widespread, but as a medical community we need to identify these disparities and make them known, so that interventions can be designed to improve access to care for all,” Dr. Larson said. “Within orthopedic surgery, scoliosis is one of the most common pediatric conditions, and if not identified early and treated with bracing, may require surgical intervention. Thus, early identification and prevention of progression is critical to the treatment of scoliosis.” 

Dr. Larson and co-authors conclude that primary care providers, pediatricians and scoliosis screeners must be comprehensively educated on identifying scoliosis and the risks associated with late identification of it. Furthermore, public health initiatives such as school screenings and outreach clinics can further address the disparity in access to care for the diagnosis and management of scoliosis in communities at risk for late presentation of scoliosis. 

“While I am humbled by the results of our study, I am motivated to make a change for the better,” Dr. Larson said. “We are excited about the community outreach opportunities Lurie Children’s offers through the mobile health unit and other public health initiatives to help minimize disparities in access to care within the Chicago area. My goal is that in 10 years, the profile of children presenting with severe scoliosis will more accurately represent our entire community without race or opportunity index causing increased risk.”  

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is a nonprofit organization committed to providing access to exceptional care for every child. It is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. Lurie Children’s is the pediatric training ground for Northwestern University Feinberg School of Medicine. 

Read the study or listen to more about it on an episode of the Pediatric Orthopaedic Society of North America’s podcast, Peds Ortho. 

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