Does social deprivation influence timely presentation of adolescent idiopathic scoliosis: a retrospective study

BACKGROUND: Delayed presentation of Adolescent Idiopathic Scoliosis (AIS) is common in the UK and is characterised by larger Cobb angles at diagnosis. The size of the Cobb angle influences the mode and effectiveness of treatment strategies and worsens the overall outcome and prognosis. Severe scoliosis typically necessitates surgical correction. We hypothesised that social deprivation may be one factor that contributes to delayed presentation. AIMS: To assess whether social deprivation is associated with greater spinal curvature at first consultation. METHODS: A retrospective study of children presenting with AIS to a major UK children's hospital between 2013 and 2022. Cobb angle and the English Index of Multiple Deprivation (IMD) 2019 rank were initially analysed as continuous variables using scatter plot visualisation and linear regression. Subsequently, a case-control analysis was performed with revised groupings: cases were defined as patients with large, neglected curves (Cobb angle > 70°) and controls as patients with nonoperative scoliosis (Cobb angle < 50°). Patients with Cobb angles between 50° and 70° (n = 31) were excluded from the case-control analysis to reduce misclassification. Statistical analysis included descriptive statistics, linear regression, and logistic regression. RESULTS: A total of 364 patients were identified. Linear regression of IMD rank against Cobb angle across the full cohort demonstrated a non-significant regression coefficient (β = 19.90, p = 0.335), with a Pearson correlation of r = 0.051. After excluding 31 patients with Cobb angles 50-70°, the case-control analysis included 113 cases and 220 controls. Logistic regression yielded an odds ratio for IMD decile of 0.992 (95% CI 0.923-1.066, p = 0.828), confirming no significant association between social deprivation and curve severity. CONCLUSION: This study did not find a significant association between social deprivation and severity of scoliosis at presentation. Findings were consistent across both continuous and categorical analyses. However, the lack of variability in the studied population and potential overmatching may have limited the ability to detect meaningful differences. Large-scale, multicentre studies are needed.