O2122: Child Opportunity Index and Age at Diagnosis of Developmental Dysplasia of the Hip

Background: Initiation of treatment for developmental dysplasia of the hip (DDH) by 6-7 weeks of age predicts a higher rate of success of treatment with a Pavlik harness. Social determinants of health can impact the time needed to access care across medical specialties. Child Opportunity Index (COI) 2.0 is a single metric designed to measure U.S. neighborhood resources and conditions that affect children’s healthy development across three domains: education, health and environment, and social and economic factors. The purpose of this study is to investigate the association between social determinants of health captured by COI and the timing to diagnosis of DDH.

Methods: This is a retrospective cohort study on patients < 4 years old diagnosed with DDH at one institution from 2016 to 2020 and requiring treatment with a Pavlik harness, abduction brace, and/or surgery. Demographic and clinical data were collected by chart review including zip code, date of initial diagnostic imaging (ultrasound, radiograph), severity of disease (acetabular dysplasia, subluxation or dislocation) and treatment. Patients with known syndromes, congenital anomalies, or neuromuscular disorders were excluded. Patients with an unknown date of initial diagnostic imaging were excluded. Subgroup analysis of patients diagnosed at ≤ 6 weeks old (“early”) and > 6 weeks old (“late”) was performed. Statewide COI 2.0 scores (total and 3 domains, range 0-100) were recorded for each zip code, as well as quintile-ranking categorical scores (very low, low, moderate, high, very high).

Results: 69 patients were included: 54 female (78.3%), median age of 29 days [IQR 47] at first diagnostic imaging. Table 1 lists COI score distribution and mean age at first diagnostic imaging. With the exception of Health-COI, the majority of patients fell into low or very low quintiles and mean age at diagnosis was lower in low or very low score quintiles. Table 2 compares “early” and “late” subgroups. Subgroups differed significantly by two risk factors for DDH (sex, breech position) and treatment with brace or surgery but not by COI.

Conclusion: In this urban children’s hospital, there were no differences in COI among patients diagnosed with DDH by ≤ 6 weeks old and > 6 weeks old. Breech position was more common in the “late” subgroup indicating a need for more timely screening ultrasounds in breech newborns. Our findings may reflect the insurances accepted at our institution (public and private) and the nature of our referral patterns. In theory, patients referred by non-affiliated pediatricians from moderate, high and very high COI zip codes residing further from the institution may potentially take a similar or longer time to access care, compared to local patients referred by affiliated pediatricians. A different practice setting and/or larger sample size could yield different results from this study.