Influence of Neighborhood Disparities on Traumatic Shoulder Instability Severity and Timing of Care in Adolescents.

Abstract

Identifying and understanding socioeconomic disparities among adolescents with traumatic shoulder instability can help to optimize care for patients by improving differences in the disease burden, disease severity, and awareness of resource limitations. Current studies evaluating disparities among patients with shoulder instability are limited to the adult population or surgical patients. To evaluate how educational, health/environmental, and social/economic disparities influence the timing of shoulder instability treatment and shoulder instability severity among adolescents. Cohort study; Level of evidence, 3. A retrospective review of patients aged 10 to 19 years diagnosed with shoulder instability from January 2022 to April 2024 at a single institution was conducted. The Child Opportunity Index (COI) was used to evaluate inequalities in educational, health/environmental, and social/economic opportunities. Disease severity was determined using magnetic resonance imaging (MRI), including glenoid bone loss, Hill-Sachs interval size, distance to dislocation, and presence of an off-track lesion. Continuous variables were analyzed with the Mann-Whitney <i>U</i> test or the Spearman correlation coefficient, while categorical variables were analyzed using the chi-square test. Significance was set at <i>P</i> < .05. There were 181 patients who met the inclusion criteria. Patients with a lower overall COI had a longer time from injury to initial presentation (<i>r</i> = -0.15; <i>P</i> = .048), injury to orthopaedic evaluation (<i>r</i> = -0.17; <i>P</i> = .027), and injury to MRI (<i>r</i> = -0.16; <i>P</i> = .033) but not from injury to surgery. A history of recurrent dislocations was associated with a lower overall COI (B = -3.27; <i>P</i> = .041), lower educational COI (B = -3.01; <i>P</i> = .009), and lower social/economic COI (B = -3.65; <i>P</i> = .049). Patients with a distance to dislocation <10 mm were associated with a lower overall COI (B = -7.59; <i>P</i> = .003), lower educational COI (B = -8.38; <i>P</i> = .045), lower health/environmental COI (B = -7.88; <i>P</i> = .006), and lower social/economic COI (B = -8.22; <i>P</i> = .001). Children living in neighborhoods with fewer educational and social/economic opportunities were associated with longer times from injury to orthopaedic evaluation and from injury to MRI for shoulder instability and were at a higher risk for recurrent shoulder dislocations.