INTRODUCTION Social determinants of health have been shown to influence the health and outcomes of pediatric patients. Adolescent idiopathic scoliosis (AIS) may be particularly sensitive to such factors as early diagnosis and treatment can obviate the need for surgical intervention. The purpose of this study was to analyze the effect that social determinants of health have on the severity of AIS at presentation and at the time of surgery. METHODS A retrospective review was conducted for consecutive patients who underwent posterior spinal fusion for AIS from 2020 to 2022. Demographic data was collected, while insurance status (private vs. public) and childhood opportunity index (COI) categories (LOW vs. HIGH) were used as a proxy for socioeconomic status. Curve magnitude at the initial presentation and at the latest preoperative visit were recorded with a threshold of 25 to 40 degrees considered within the bracing range. Univariate and multivariate analysis was done to compare differences between subgroups as appropriate. RESULTS A total of 180 patients with mean initial and preoperative major curve angles of 48 and 60 degrees were included. Statistically significant differences in race and insurance types were appreciated, with the LOW COI group having a higher proportion of underrepresented minority and publicly insured patients than the HIGH COI group (P<0.001). Patients within the LOW COI group presented with an initial curve that was, on average, 6 degrees more severe than those within the HIGH group (P=0.009) and a preoperative curve that was 4 degrees larger than those within the HIGH group (P=0.015). Similarly, only 13% of patients within the LOW COI group presented with curves within the bracing threshold, compared with 31% in the HIGH COI group (P=0.009). CONCLUSION Socioeconomic status plays a significant role in the severity of AIS. Specifically, patients with lower COI tend to present with curve magnitudes beyond what is responsive to nonsurgical treatment, leading to larger curves at the time of surgery. Future work should focus on addressing social inequalities to optimize the treatment and outcomes of AIS patients. LEVEL OF EVIDENCE Level III- Retrospective Comparative Study.

中文翻译：

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健康的社会决定因素对青少年特发性脊柱侧凸曲线严重程度的影响。

引言 健康的社会决定因素已被证明会影响儿科患者的健康和结果。青少年特发性脊柱侧凸（AIS）可能对此类因素特别敏感，因为早期诊断和治疗可以避免手术干预的需要。本研究的目的是分析健康的社会决定因素对就诊时和手术时 AIS 严重程度的影响。方法 对 2020 年至 2022 年因 AIS 接受后路脊柱融合术的连续患者进行回顾性分析。收集人口统计数据，同时分析保险状况（私人与公共）和儿童机会指数 (COI) 类别（低与高）。用作社会经济地位的替代指标。记录初次就诊时和最近一次术前就诊时的曲线幅度，阈值为 25 至 40 度，考虑在支撑范围内。进行单变量和多变量分析以酌情比较亚组之间的差异。结果 总共纳入了 180 名患者，平均初始和术前主曲线角度分别为 48 度和 60 度。种族和保险类型之间存在统计学上的显着差异，低 COI 组中代表性不足的少数族裔和公共保险患者的比例高于高 COI 组（P<0.001）。低 COI 组患者的初始曲线平均比高组患者严重 6 度 (P=0.009)，术前曲线比高组患者大 4 度 (P= 0.015）。同样，低 COI 组中只有 13% 的患者曲线在支撑阈值内，而高 COI 组中这一比例为 31% (P=0.009)。结论 社会经济地位对 AIS 的严重程度起着重要作用。具体来说，COI 较低的患者往往会出现超出非手术治疗反应范围的曲线幅度，导致手术时出现较大的曲线。未来的工作应侧重于解决社会不平等问题，以优化 AIS 患者的治疗和结果。证据级别 III 级 - 回顾性比较研究。