Does Socioeconomic Status Affect Severity of Neuromuscular Scoliosis at the Time of Surgery?

Abstract

Pediatric patients with severe neuromuscular scoliosis (NMS) often require posterior spinal fusion (PSF) surgery. Curve magnitude, among other comorbidities, is a risk factor for worse postoperative outcomes, but social determinants of health also have large effects on patient outcomes. Our hypothesis was that lower socioeconomic status (SES), race, and public insurance status independently affect preoperative diagnosis severity for children with NMS. We used the area deprivation index (ADI) and insurance type to stratify groups for analysis. Higher ADI indicates higher socioeconomic deprivation. We studied 216 patients with NMS who underwent PSF of >13 levels from 2015 to 2020 at our institution. χ2 tests for independence α < 0.05, T-tests, analysis of variance, and Pearson correlations were used to analyze clinical variables to determine whether diagnosis severity at presentation depended on ADI, insurance type, or race. Patients with higher ADI had larger preoperative curves (P = 0.002) and higher outpatient no-show rates (P < 0.001) were more likely to be from single caregiver households (P = 0.031), publicly insured (P < 0.001), and non-White (P < 0.001). Publicly insured patients had more comorbidities (P = 0.029), higher outpatient no-show rates (P < 0.001), and mean ADI (P < 0.001) were less likely to seek second opinions (P < 0.001) and more likely to be from single caregiver households (P < 0.001). Non-White patients had a higher mean ADI (P < 0.001) and higher no-show rates (P < 0.001) were more likely to be publicly insured (P < 0.001) and presented with more comorbidities (P = 0.014). SES has notable effects on patients with NMS, as those with lower SES and public insurance presented with greater preoperative curve magnitudes, more comorbidities, and higher outpatient no-show rates. Greater diagnosis severity at presentation may affect outcomes afforded by surgery and pose a higher risk of postoperative complications. This population at risk should be identified preoperatively and provided education and resources to mitigate the effect of SES on diagnosis severity before PSF for NMS. III.