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

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.