Does Diversity Matter? Disparities in Diagnostic Delays and Contralateral Risk Factors in Slipped Capital Femoral Epiphysis

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2022-12

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Abstract

The skeletal pathology slipped capital femoral epiphysis (SCFE) is one of the more common hip diseases that can affect adolescents. Delays in diagnosis and the risk of contralateral SCFE are recognized issues for this patient population. However, SCFE studies often do not include the groups of people most often diagnosed with this pathology, namely Black and Hispanic individuals. This project aimed to address this literature gap by investigating the recognized issues with a sizeable sample of individuals in those ethnic groups, roughly equal to the White patient group. We found that the severity of SCFE measured by Southwick slip angle (SSA) is significantly associated with both insurance type and patient status. Patients who were covered by private insurance or were already an established patient at the medical center were more likely to be diagnosed with mild SCFE, and patients with no insurance had a significantly higher mean SSA than patients with insurance. Posterior sloping angle (PSA) and physeal sloping angle in the anterior-posterior view (PSA-AP) are two of the most often used measurements to estimate contralateral slip risk. They were not predictive of contralateral slip risk in our sample, except for PSA-AP in male patients. When analyzed within each ethnic subgroup, we found significant differences in the PSA and PSA-AP between males and females within the Hispanic patient sample only. This suggests that these angles are not necessarily predictive for all patients groups, and/or that there may be sex differences within patient populations that can affect the utility of these metrics. To the authors' knowledge, the above findings are the first to link SSA to insurance status and patient status, and to the first to analyze the PSA and PSA-AP angles of a Hispanic SCFE patient group.

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