Disparities Research in Pediatric Orthopaedic Surgery: Is the Needle Moving?

Background: Disparities in health care are well documented and may have major medical and socioeconomic implications in populations that are already marginalized. While research identifying disparities is important, community partnerships and interventions to address inequities are critical to establish long-term infrastructure and lasting impact. The purpose of this study is to investigate trends and characteristics of disparities research in pediatric orthopaedics, with attention to study design, intervention implementation, and federal funding.

Methods: The Web of Science platform was queried for English-language articles in the Orthopedics or Sports Sciences categories between 2013 and 2022 with the following keywords: "disparities", "disparity", "inequity", "inequities", "diversity", "socioeconomic", "sex", "gender", "insurance", "race", and "neighborhood". Book chapters, meeting abstracts, proceedings papers, and retracted publications were excluded. Abstracts were reviewed manually to determine study inclusion. Descriptive statistics were calculated to report study characteristics, federal funding, and the evaluation of interventions to address disparities.

Results: The initial query yielded 7274 articles, of which 69 addressed disparities or diversity topics in pediatric orthopaedics. Fifty (72.4%) were published between 2019 and 2022, and 32 (46.4%) were published in 2021 and 2022. The vast majority of studies (73.9%) had a retrospective design. No studies primarily utilized qualitative methods or a community-engaged approach. Most articles either analyzed multiple determinants (40.6%) or only focused on insurance (21.7%) or sex/gender (17.4%). No publications designed an original intervention and empirically studied its impact. No studies were directly funded by the National Institutes of Health.

Conclusions: There is an increasing volume of disparities research in pediatric orthopaedics, with most articles published in 2019 or later. Most studies are retrospective, unfunded, and describe a disparity rather than implement an intervention. Future efforts should be dedicated to prospective and qualitative methodology, community engagement, increased federal funding, and interventions to reduce inequities.

Level of evidence: N/A (bibliometric study).