Influence of Insurance Status on Curve Magnitude in Adolescent Idiopathic Scoliosis in Mainland China

Abstract

Study Design: Retrospective cohort study. Objectives: To determine whether there is an association between insurance status and curve magnitude in idiopathic scoliosis pediatric patients in mainland China. Methods: Medical records of patients with adolescent idiopathic scoliosis in 4 tertiary spine centers across China from January 2013 to December 2017 were analyzed. Data was extracted on insurance status, curve magnitude, recommended treatment at presentation, source of referral, and treatment initiated. Additional information was collected for patients requiring corrective surgery, including time from recommendation for surgery to surgery and clinically relevant parameters such as, postoperative complications, and pre-/postoperative Scoliosis Research Society–22 scores were also collected for patients requiring corrective surgery. Results: Of the 1785 patients included, 1032 were Urban Resident Basic Medical Insurance Scheme (URBMS) insured and 753 were New Rural Cooperative Medical Scheme (NRCMS) insured. NRCMS patients presented with a larger major curve than URBMS patients (32.9° ± 15.1° vs 29.3° ± 12.6°, P = .028). For patients having surgery recommended, NRCMS patients presented with a larger mean Cobb angle at the first presentation (57.7° vs 50.9°, P < .0001) and at time of surgery (61.3° vs 52.2°, P < .0001), and experienced a significantly longer time from surgery recommendation to decision for surgery. Complication rates were comparable between the 2 groups, except for pulmonary complications (NRCMS 7.3% vs URBMS 2.8%, P = .04). Postoperatively, patients covered by NRCMS insurance experienced greater overall improvement in health-related quality of life and were less satisfied with the treatments. Conclusions: This study shows that health insurance may influence the severity of scoliosis on presentation, with implications on early diagnosis and surgery time.

Disparities in Pediatric Scoliosis: The Impact of Race and Insurance Type on Access to Nonoperative Treatment for Adolescent Idiopathic Scoliosis

“…Prior research has provided inconsistent results regarding the effect of healthcare disparities on the quality of care for AIS patients due to small sample size, lack of diversity within the study population, and incomplete geographic coverage. [11][12][13][14] These studies tended to isolate one variable, predominantly race or insurance status, without exploring the potential complex interactions between various socioeconomic factors. In the current study, we sought to further assess the interaction of socioeconomic factors on healthcare disparities associated with the treatment of pediatric spine deformity in our previously unstudied geographic region.…”

“…Prior research has provided inconsistent results regarding the effect of healthcare disparities on the quality of care for AIS patients due to small sample size, lack of diversity within the study population, and incomplete geographic coverage 11–14. These studies tended to isolate one variable, predominantly race or insurance status, without exploring the potential complex interactions between various socioeconomic factors.…”

Is the Child Opportunity Index a Factor in Surgical Outcomes for Adolescent Idiopathic Scoliosis?

“…Many studies have been conducted to assess the potential risk factors that may contribute to advanced AIS curvature before surgery, including the effects of SES. 2,3,6 There is contention surrounding the topic of SES and AIS curve magnitude. 3,6 It is also unclear what measure of SES is the most accurate to use (eg zipcodes, ADI, and COI).…”

“…Previous research has suggested a child's socioeconomic status (SES) may affect the timing of when they first present to the orthopaedic clinic. [2][3][4][5] Specifically, children from low SES backgrounds are more likely to experience longer referral times and delays in orthopaedic treatment than those from higher SES backgrounds. [2][3][4][5] Furthermore, Russell et al 3 demonstrated that patients with AIS using government insurance were more likely to present with greater major coronal curve angles than those using private insurance plans, but this was of questionable clinical significance.…”

“…However, many patients present at older ages with advanced curves, increasing their odds of surgical intervention. Previous research has suggested a child’s socioeconomic status (SES) may affect the timing of when they first present to the orthopaedic clinic 2–5 . Specifically, children from low SES backgrounds are more likely to experience longer referral times and delays in orthopaedic treatment than those from higher SES backgrounds 2–5 .…”