P3.164: Lower COI in Pediatric Spine Patients Predict Lower PROMIS Scores

Background: Social determinants of health can influence manifestations of musculoskeletal disease and health in many ways. Here we aim to evaluate the potential influence of social determinants of health on patient-reported outcome measures among pediatric patients presenting for evaluation to a pediatric orthopaedic spine clinic.

Methods: We retrospectively identified 1,630 pediatric patients presenting for initial evaluation to a quaternary care orthopaedic spine clinic between December 31, 2019, and December 31, 2023. Childhood Opportunity Index (COI) was defined by census tract and reported across three domains (Social/Economic, Education and Health/Environment). Patient demographic data, insurance type, and BMI were obtained through chart review. Multivariable linear regression was used to analyze the effect of COI on Patient-Reported Outcomes Measurement Information System (PROMIS) assessments of Physical Activity, Mobility, Peer Relationships, Anxiety, Depressive Symptoms, Physical Stress Experiences, Pain Behavior and Pain Interference.

Results: Our cohort consisted of 1,630 patients with a mean age of 14.2 (SD: 2.3, range 8.1-21.8). Upon univariate analysis, lower COI’s were associated with worse scores on all PROMIS subdomains. After adjusting for age, BMI, sex, race, ethnicity, and insurance type, decreased educational opportunity was associated with decreased physical activity (p < 0.001) and Decreased social/economic opportunity was associated with decreased mobility and increased anxiety (p=0.006; p=0.016).

Conclusion: Educational, social, and economic opportunities in a patient’s local community were significantly associated with worse baseline patient-reported outcomes for children presenting to a spine clinic. Identifying existing disparities is the first step in addressing the systemic inequities that negatively affect the health of children from marginalized backgrounds.