409 - The Language of Health Equity: Assessing the Impact of Preferred Language on the Treatment of Early Onset Scoliosis

Publication Number: 409.6909

Kevin Sun, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Annika Y. Myers, CHLA, Los Angeles, CA, United States; Nikita S. Iyer, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States; Jacquelyn N. Valenzuela-Moss, Children's Hospital Los Angeles, Los Angeles, CA, United States; Tishya Wren, Children's Hospital Los Angeles, Los Angeles, CA, United States; Tyler A. Tetreault, Children's Hospital Los Angeles, Los Angeles, CA, United States; Lindsay Andras, Children's Hospital Los Angeles, Los Angeles, CA, United States; Michael Heffernan, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: There is a paucity of literature assessing the impact of socioeconomic factors on Early Onset Scoliosis (EOS). Further, assessment of preferred language has not been explored as a potential barrier to scoliosis care.

Objective: This study assessed the interactions between cultural and socioeconomic differences and outcomes of EOS treatment. We hypothesized that socioeconomic factors would impact curve magnitude at initial presentation, timing of surgical treatment, and complications in EOS patients.

Design/Methods: Patients treated for EOS from a single tertiary children’s hospital were analyzed. Data collection included race, ethnicity, preferred language, insurance status, curve magnitude, days from treatment recommendation to date of treatment, and complications. T-tests and Mann-Whitney tests were used to compare curve magnitude by language, insurance status, and ethnicity. Kruskal-Wallis tests were utilized to compare curve magnitude and timing to treatment by race.

Results: EOS patients were identified from a single center’s early onset scoliosis database. Of this cohort, 181/244 (73.9%) spoke English and 64/181 (26.1%) spoke Spanish as their preferred language. 155/244 (63.5%) patients had public insurance, 86/244 (35.3%) had private insurance, and 3/244 (1.2%) were uninsured. A greater proportion of Spanish-speakers were publicly insured compared to English-speakers (56/64, (87.5%) vs 102/180 (56.7%), p< 0.001). More than half (52.7%) of our cohort identified as Hispanic. Overall, curve magnitude at initial presentation did not differ between groups based on race, insurance, or language (p>0.05). 35% of Spanish speakers had a complication compared to 22% of English speakers. Spanish-speaking Hispanics experienced longer time to receive treatment compared to Hispanic and non-Hispanic English-speaking patients. (167.5 (IQR 143) vs 114 (IQR 110) days, p=0.020). Among those publicly insured, Spanish-speakers experienced longer wait times between surgery recommendation and surgical intervention than English-speakers (146 (IQR 77) vs 113 (IQR 81) days, p=0.039). In contrast, Spanish-speakers with private insurance had wait times similar to their English-speaking peers (p=0.688).

Conclusion(s): Socioeconomic factors such as primary language and insurance status may contribute to delays in surgical timing and risk of complications. Based on the results of this study, further evaluation of potential barriers to care may be needed for patients who identify Spanish or other non-English languages as their preferred language.