Background: The impact of socioeconomic status (SES) on health outcomes is an increasingly important topic. Identifying which patients are more likely to present with advanced musculoskeletal pathology is a top priority. The Area Deprivation Index (ADI) ranks neighborhoods across the United States based on socioeconomic disadvantage. The Childhood Opportunity Index 2.0 (COI 2.0) measures community resources and ranks neighborhoods according to the social determinants of health. Our study aimed to determine the relationship between scoliosis curve magnitude at presentation and SES as measured by the ADI and COI 2.0.

Methods: We retrospectively identified 1,649 patients presenting for adolescent idiopathic scoliosis at a single academic center between June 27, 2018 and June 6, 2023. The patients were divided into a non-surgical and surgical cohort with 1,510 and 139 patients, respectively. Curve magnitude at initial presentation (Cobb angle), BMI, and address were recorded using the electronic health record. Patients’ addresses were used to determine their ADI and COI 2.0 scores. The information was assessed using univariate analysis.

Results: Patients in the surgical cohort were more likely to have a higher ADI National Percentile, higher ADI State Decile, higher BMI, and greater Cobb angle at presentation compared to the non-surgical cohort (p = <0.05). Within the surgical cohort, patients with a higher BMI were more likely to have a greater Cobb angle at initial presentation (p = <0.05). Within the non-surgical cohort, patients with a Cobb angle >45 were more likely to have a higher ADI State Decile and live in neighborhoods with a higher poverty rate compared to patients with a curve <45 (p = <0.05). Within the non-surgical cohort, patients with a Cobb angle >45 were more likely to live near hazardous waste dump sites compared to patients with a curve <45 (p = <0.05).

Conclusion: There are significant associations between SES and scoliosis curve magnitude at presentation. Patients that have undergone surgery are more likely to be socioeconomically disadvantaged at a state and national level, according to the ADI. Non-surgical patients with a greater amount of socioeconomic disadvantage at the state level, those who live in neighborhoods with higher poverty rates, and those with greater environmental pollutant exposure are more likely to present with a Cobb angle that exceeds bracing indications (>45). More work must be done on a state and national level to identify, treat, and educate socioeconomically disadvantaged patients before their curve magnitude exceeds non-operative management.

The Impact of Socioeconomic Status on the Magnitude of Scoliosis Curve at Initial Presentation

 Orthopaedic Surgery

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