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Healthcare disparities in adult and pediatric spinal deformity: a state of the art review

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Abstract

Purpose

A health disparity refers to a greater disease burden or negative health outcomes influenced by social, economic, and environmental factors. Numerous studies in the surgical literature show that social drivers of health affect health outcomes. Similar disparities may affect treatment and outcomes of spine deformity patients. This study aims to review existing literature on healthcare disparities in patients with spinal deformities.

Methods

A comprehensive search of articles from 1/2002 to 7/2024 in two databases included keywords and Medical Subject Heading terms: “health disparities,” “scoliosis,” “social determinant of health,” “disparities,” “spine deformity,” and “race”. The 22 studies that met the inclusion criteria were U.S.-based, English-language, peer-reviewed research covering all age groups. Exclusion criteria excluded studies unrelated to spinal deformity and case reports.

Results

The search resulted in 22 potential articles investigating health care disparities in spinal deformity patients. Black patients were noted to present with disease progression compared to White patients. Females have a longer length of stay (LOS) than males. The Black and Hispanic patients had longer LOS than Whites. The privately insured patients were more likely to receive timely care than Medicaid recipients.

Conclusion

The consensus across much of the literature reviewed indicate that surgeon volume, hospital volume, sex/gender, race/ethnicity, socioeconomic status, and insurance status impact patient outcomes in adult and pediatric spinal deformity. Prospective studies and solutions to address these disparities are needed.

Level of evidence

Level III.

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Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Washington Hospital Center, Washington, DC, USA

    Lancelot Benn & Addisu Mesfin

  2. Department of Orthopaedics and Physical Performance, University of Rochester, Rochester, NY, USA

    Tarek Yamout & Adwin Denasty

  3. AACD, Association for the Assistance of Disabled Children, Sao Paulo, Brazil

    Mauro Costa Morais Tavares Junior & Olavo Biraghi Letaif

  4. Pediatric Specialists of Virginia, Fairfax, VA, USA

    Laurel C. Blakemore

  5. Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

    Serena S. Hu

  6. Department of Orthopaedic Surgery, NYU/Langone, New York, NY, USA

    Qusai Hammouri

  7. Department of Orthopaedic Surgery, Duke University, Durham, NC, USA

    Joe Minchew

  8. Department of Neurosurgery, The University of Oklahoma College of Medicine, Oklahoma, OK, USA

    Isaac Karikari

  9. Department of Neurosurgery, University California, San Diego, CA, USA

    Joseph Osorio

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  1. Lancelot Benn
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Contributions

Lancelot Benn: writing/original draft preparation, draft preparation, approval of final version of manuscript, major revision to initial manuscript, agree to be accountable for the work; Tarek Yamout: data collection,, approval of final version of manuscript, agree to be accountable for the work; Mauro Costa Morais Tavares Junior: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Adwin Denasty: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Laurel C. Blakemore: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Serena S. Hu: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Qusai Hammouri: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Joe Minchew: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Isaac Karikari: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Joseph Osorio: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Qusai Hammouri: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Olavo Biraghi Letaif: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work; Addisu Mesfin: data collection, writing/original draft preparation, approval of final version of manuscript, agree to be accountable for the work.

Corresponding author

Correspondence to Addisu Mesfin.

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Conflict of interest

Lancelot Benn declares that he has no conflict of interest. Tarek Yamout declares that he has no conflict of interest. Adwin Denasty declares that he has no conflict of interest. Mauro Costa Morais Tavares Junior declares that he has no conflict of interest. Laurel C. Blakemore: consulting agreement Medtronic, Royalties Stryker Spine, BOD for Scoliosis Research Society, Pediatric Spine Foundation, committee member POSNA, Chair of Medical Advisory Board Shriner’s Hospitals for Children. Serena S. Hu declares that she has no conflict of interest relevant to this article. Qusai Hammouri declares that he has no conflict of interest. Joe Minchew declares that he has no conflict of interest. Isaac Karikari,MD declares that he has no conflict of interest. Joseph Osorio declares that he has no conflict of interest. Olavo Biraghi Letaif declares that he has no conflict of interest. Addisu Mesfin owns Equity in Axiomed, Efficient Surgical Apps, Grant support: Nuvasive, Consultant: Nuvasive, serves on committees of SRS, CSRS, LSRS, NASS, JRGOS, AOA.

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Benn, L., Yamout, T., Tavares Junior, M.C.M. et al. Healthcare disparities in adult and pediatric spinal deformity: a state of the art review. Spine Deform (2024). https://doi.org/10.1007/s43390-024-01012-9

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