I live in California and teach in a local high school. My partner teaches in a private school. Sometimes we compare notes about equalities and inequalities we think we see. One of those is health care. I never see anyone in my classes wearing a brace for scoliosis and certainly never having surgery for this problem. My partner reports this is much more likely in the private sector. The reason I ask is because my daughter has scoliosis, too so this problem has caught my eye. What do you know about this kind of difference in treatment?

Your observations may be more on the mark than you think! And, in fact, other folks in your area have noticed the same thing. Researchers at Cedars-Sinai Medical Center in Los Angeles, California used information from the Nationwide Inpatient Sample or NIS to compare the number and types of patients who had spinal fusion surgery for idiopathic scoliosis. They also analyzed information on postoperative complications.

The NIS is a computer database with information collected on all patients who enter a hospital. Patient demographics (e.g., age, sex, race, income, insurance information, education) and hospital characteristics (e.g., size, bed capacity, teaching versus nonteaching) can be evaluated. Data collected in the NIS do not reflect the severity of each person’s scoliosis, the presence of other spinal problems, or the reasons why surgery was done. But trends in treatment can be detected.

According to this study, if you have idiopathic scoliosis, you are more likely to be treated surgically if you are 1) white, 2) have private insurance, and 3) have access to a large hospital. These racial and socioeconomic trends represent differences in treatment between white and non-whites referred to as disparities in health care.

As mentioned, whites or Caucasians had the highest rate of surgery for idiopathic scoliosis. Patients with private insurance were two times more likely to have spinal fusion surgery for this condition. Non-Caucasians (African Americans, Hispanics, Asian/Pacific Islanders, Native Americans) were much more likely to have complications after surgery.

Hispanic patients had the highest rate of complications. In all age groups and for all races and income levels, pulmonary (lung) problems were the most common followed by hematoma (bleeding). African Americans were more likely to suffer cardiac complications. Their death rate was also the highest. This finding was attributed to “less frequent use of effective cardiac medications” and “poorer overall quality of care” for this group.

The authors concluded that like so many other studies that show health care disparities based on race and ethnicity, surgical treatment of idiopathic scoliosis follows the same trend. Bringing these patterns to the awareness of policy makers may help solve this complex problem. There may be cultural reasons for some of the differences that must also be addressed. For example, minority patients are less likely to accept recommended services or treatment and less likely to follow through with treatment suggestions.