# Disparities in spinal deformity surgery care for children with cerebral palsy and neuromuscular scoliosis

## TL;DR

This study found health disparities in spinal surgery care for children with cerebral palsy and scoliosis, linked to race, insurance type, language, and distance from the hospital.

## Contribution

The study identifies specific demographic and socioeconomic factors associated with disparities in spinal deformity surgery care for children with cerebral palsy.

## Key findings

- Black race and government insurance were linked to larger spinal curve magnitudes at presentation.
- Non-English language preference was associated with longer delays in surgery after recommendation.
- Geographical distance from the hospital correlated with larger curve magnitudes.

## Abstract

To assess potential disparities in care for non-ambulatory children with cerebral palsy (CP) and associated neuromuscular scoliosis treated at a quaternary pediatric hospital.

This retrospective cohort study included non-ambulatory children CP who received spinal deformity surgery between 01/2012 and 12/2022. Demographic, clinical, and radiographic data were collected. Relationships between demographic factors and clinical/radiographic data were assessed using Fisher’s Exact Test, Wilcoxon Rank-Sum test, Kruskal–Wallis one-way ANOVA, and linear regression models.

Of 502 children identified, 328 met eligibility criteria. The mean age of the sample was 9.8 ± 4.0 years, 59% were male. On presentation, the average major coronal curve magnitude was 46 ± 23˚. Most (70%) were White, 13% were Black, 6% were Hispanic or Latino, and the remaining participants were Asian, Pacific Islander, Native American, Alaska Native, or declined to answer. Most spoke English (89%). Just under half (45%) had both government and commercial insurance and 24% had only government insurance. Black compared to White race (p = .03), government compared to commercial insurance (p = .02), and farther distance from hospital (p < .001) were associated with larger curve magnitudes at presentation, after adjustment for covariates. Non-English language (p = .002) was associated with longer time from surgical recommendation to surgery, after adjustment for covariates.

Health disparities were identified related to ethnicity, race, preferred language, and geographical distance from the hospital for children with CP and neuromuscular scoliosis. These findings highlight the need for development of standardized criteria for surveillance, imaging, and referral to reduce health disparities for this specific population.