Health Disparities in Adolescent Idiopathic Scoliosis: Utilizing COI and ICE as Predictors of Initial Curve Magnitude and Risk for Progression 1 Year Later

Background: Adolescent idiopathic scoliosis (AIS) is a common pediatric spinal deformity, with disparities in care often linked to socioeconomic status (SES). The Childhood Opportunity Index (COI) and Index of Concentration at the Extremes (ICE) are SES markers that have been used to evaluate health disparities in orthopaedic care. The utility of these SES markers in identifying differences in AIS presentation remains unclear. Methods: Medical records between 2017 and 2020 were reviewed for patients newly diagnosed with AIS from our city-center institution with around 600,000 patient encounters annually from all communities. Patient home addresses were used to assign nationally available COI 2.0 and ICE scores. COI, which ranges from 0.0 to 100.0, was categorized into quintiles: very low (<20.0), low (20.0 to 39.9), moderate (40.0 to 59.9), high (60.0 to 79.9), and very high (>80.0). ICE was divided into ICE White versus Black income (ICEwbinc) and ICE White, Black, and Hispanic income (ICEwnhinc), with scores ranging from −1 to 1. SES markers were evaluated for associations with major curve angle magnitude at presentation and at 1-year follow-up. Results: Of 486 eligible patients, 330 (67.9%) were female. The mean major curve angle at presentation was 26 degrees. Average COI was significantly higher in White patients (73.6) compared with Hispanic patients (30.4; P <0.001). ICEwbinc (0.4 vs. 0.0; P <0.001) and ICEwnhinc (0.33 vs. −0.1; P <0.001) were highest in White patients and lowest in Hispanic patients. Very low COI was associated with the highest average body mass index (23.4) compared with the very high COI group (20.5; P <0.001). SES markers were not associated with major curve angle at presentation and 1-year follow-up. Conclusions: SES markers were not associated with AIS presentation or progression. These findings contribute to the growing literature showing that equitable access to AIS care is increasing across the nation. Future studies should focus on the role of early clinical detection contributing to equal access to AIS care. Level of Evidence: Level III—retrospective comparative study.