Primary healthcare use prior to hospital consultations for spinal disorders among Danish children and adolescents: A descriptive nationwide registry-based study

Hospital-based spine-related diagnoses in children are often preceded by substantial healthcare use, but patterns and determinants remain poorly understood. This study aimed to describe pre-hospital primary healthcare use according to parental spine-related hospital diagnoses, the child's comorbidity burden, and household income. We conducted a nationwide, registry-based cohort study including all Danish children aged 2-17 years with a first hospital-based spine-related diagnosis between 2009 and 2022 (n = 46,497). Healthcare services with general practitioners (GP), chiropractors, physiotherapists, and office-based specialist providers in the two years prior to diagnosis were quantified. Primary healthcare use was described across age groups, parental spine-related hospital diagnoses, the child's comorbidity burden, and income tertiles. In the two years before diagnosis, children had a median of 9 reimbursed GP services (IQR [5-17]), 0 chiropractor services [0-0], 0 physiotherapy services [0-0], and 0 office-based specialist services [0-1]. GP use was common, whereas use of non-GP providers was highly skewed, with most children having no or few reimbursed services and a smaller subgroup having repeated service use. Descriptive patterns of healthcare use varied according to parental spine-related hospital diagnoses and comorbidity burden. Healthcare use showed no clear descriptive gradient across household income groups. CONCLUSION: Patterns of primary healthcare use varied according to parental spine-related hospital diagnoses and comorbidity burden. No clear overall income gradient was observed, although patterns varied by provider type. These findings describe heterogeneous pre-hospital primary healthcare use in this population. WHAT IS KNOWN: • Spinal pain is common in children and is associated with substantial burden, including school absence and later risk of chronic pain. • Hospital-based spinal diagnoses in children are increasingly non-specific and often represent conditions that could be managed in primary care. WHAT IS NEW: • Higher primary healthcare use was observed among children with greater comorbidity burden and among those with parental spine-related hospital diagnoses. • Differences in total primary healthcare use across household income groups were small, with no clear income gradient.