Health Inequality In Pediatric Athletes With Musculoskeletal Injuries

Musculoskeletal injuries continue to be a common problem for the growing number of youth participating in sport and physical activity. Delaying diagnosis and treatment of injury increase the likelihood of poorer outcomes, risk of secondary injury, and overall time loss in sport and physical activity. It has been acknowledged that disparities exist in US healthcare due to various health inequities such as delay in access to care. PURPOSE: To examine differences in access to care based on insurance type and race/ethnicity of pediatric patients. METHODS: Clinic data from 227 patients being evaluated for ACL injury during 2017-2022 were extracted to calculate days to evaluation from injury and days to surgery from injury. Patients were stratified based on insurance type (Government, Commercial) and race/ethnicity (Minority, Non-Minority). RESULTS: Government and commercial insurance represented 68.3% and 31.7% of the patients. Minority patients represented 85.0% of those on government insurance and 37.5% on commercial insurance. Patients with government insurance experienced longer delays from injury to evaluation (Government: 62.3 ± 157.5 days, Commercial 13.7 ± 27.0 days, p < 0.001) and from injury to surgery (Government: 95.6 ± 168.2 days, Commercial 48.8 ± 74.4 days, p = 0.002). Minority patients regardless of insurance type experienced longer delays from injury to evaluation (Minority: 60.0 ± 153.3 days, Non-Minority 18.6 ± 63.3 days, p < 0.001) and from injury to surgery (Minority: 97.2 ± 167.8 days, Non-Minority 45.5 ± 74.4 days, p < 0.001). A significant relationship was identified between insurance type and race/ethnicity (χ2 < 0.001). CONCLUSIONS: Patients with government insurance or of race/ethnicity minority experienced clinically longer times to evaluation and surgery from injury. These findings are consistent with previous research citing social determinants of health as causal factors contributing to delays in care, ultimately creating health disparities across diverse insurance categories and racial/ethnic groups.