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Investigating the Relationship Between Neighborhood Social Deprivation and Time to Specialty Orthopedic Care for
Caroline H Lindsey1, Colin H Beckwitt2, John R Fowler2
1University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
Children with trigger thumb in high area deprivation index (ADI) neighborhoods experience longer waits for orthopedic care. This suggests a need to improve access to pediatric hand specialty services for underserved populations.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Health Services Research
Background:
- Pediatric trigger thumb is a common condition requiring referral to specialty care.
- Access to pediatric hand specialty care can be influenced by socioeconomic factors.
- Area deprivation, measured by the Area Deprivation Index (ADI), is a key social determinant of health.
Purpose of the Study:
- To investigate the relationship between area deprivation and the time from primary care referral to specialty care presentation for pediatric trigger thumb.
- To determine if socioeconomic factors impact timely access to pediatric hand surgical services.
Main Methods:
- Retrospective analysis of 163 pediatric patients diagnosed with trigger thumb.
- Area Deprivation Index (ADI) was used to quantify patient-level area deprivation.
- Examined the correlation between ADI and demographics, treatment type, and time to initial hand surgical visit.
Main Results:
- A weak positive correlation was found between higher ADI and increased time from referral to initial orthopedic hand specialist visit.
- No significant differences in ADI were observed between sexes or between patients receiving surgical versus nonsurgical management.
- The median time from referral to presentation was 34 days, with 72.4% undergoing surgical release.
Conclusions:
- Pediatric trigger thumb patients from higher ADI areas experience a slight delay in accessing specialty orthopedic care.
- Area deprivation did not influence treatment modality (surgical vs. nonsurgical) or patient sex.
- Findings suggest potential disparities in accessing timely pediatric hand care based on neighborhood socioeconomic status.
Purpose:
Pediatric trigger thumb is a common condition resulting in referral from primary care to specialty care. Access to pediatric hand specialty care is a complex issue influenced by a multitude of social factors, including socioeconomic status. The aim of this study is to investigate the relationship between area deprivation and the time from primary care referral to presentation to specialty care for pediatric trigger thumb.
Methods:
Participants were pediatric patients with trigger thumb. Patient-level area deprivation was reflected by the area deprivation index (ADI). We analyzed the relationship of the ADI to patient demographics (age and sex), trigger thumb treatment (surgical vs nonsurgical), and time to initial hand surgical visit after referral and surgical management when indicated.
Results:
Among 163 patients with trigger thumb, 52% were men. Mean age at referral for trigger thumb was 2.9 ± 1.7 years. Mean ADI for patients diagnosed with trigger thumb was 57.8 ± 23.4 for the 2018 data set and 57.3 ± 23.6 for the 2021 data set, on a scale of 1 (low) to 100 (high). The median time from referral from primary care to presentation to orthopedic care for trigger thumb was 34 days. Upon presentation to treating hand surgeon, 118 patients (72.4%) underwent surgical release. We found no difference in ADI between men and women nor between patients treated operatively or with nonsurgical management. We found a weak positive correlation between ADI and time from initial referral to presentation to the treating hand surgeon. There was no correlation between ADI and time from initial hand surgical evaluation and surgical management in patients indicated for surgery.
Conclusions:
Pediatric trigger thumb patients from areas with higher ADI have a slightly longer delay between initial referral and their initial visit with an orthopedic hand specialist. Although we found a delay in initial evaluation by the treating hand surgeon in patients with higher ADI, ADI status was not different between patients managed with surgical and nonsurgical treatment nor between men and women.
Clinical Relevance:
Neighborhood ADI weakly correlated with increased time from referral to accessing specialty orthopedic care for trigger thumb. This may suggest a need for more equitable access to specialty care for patients with pediatric trigger thumb from high ADI areas.
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