The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review.

Abstract

Purpose: Adolescent idiopathic scoliosis (AIS) has been associated with significant physical and psychosocial burdens. Social determinants of health play a well-documented role in treatment and outcomes of various conditions, including AIS. As such, it is crucial to understand the multifaceted socioeconomic factors that may affect its prevalence and severity.

Methods: A comprehensive search of major bibliographic databases such as Medline, Embase, and Cochrane Library was conducted from inception to August 2024 for studies examining AIS in marginalized populations. Demographical and clinical outcomes data were extracted for quantitative and qualitative analyses.

Results: Our initial search identified 479 articles, of which 14 met the eligibility criteria. The mean age was 14.1 years, 76.8% were females, 59.6% were White, and 73.6% had private insurance. Black adolescents with AIS presented with more severe forms of the condition that necessitated surgical management. Furthermore, lower socioeconomic status, along with residence in socioeconomically disadvantaged neighborhoods and enrollment in public insurance programs, often contributed to delayed clinical presentation, more severe curves at initial presentation, and delayed treatment.

Conclusion: This systematic review revealed disparities in the diagnosis and management of AIS based on race, ethnicity, language, insurance status, and socioeconomic status. These disparities highlight the urgent need for a multifaceted approach to improve equity in AIS care. Addressing these challenges requires systemic reforms targeted towards enhancing access and treatment for marginalized populations. Focused interventions should consider the unique social determinants that contribute to these disparities, ultimately promoting a more equitable healthcare system for all adolescents affected by idiopathic scoliosis.

Level of evidence: Level II.