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High Burden of Social Risk Factors in the Pediatric Orthopaedic Population: A Single-Center Analysis
Devika A Shenoy1, Evan Schrader, Elizabeth Sachs
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
Background:
The prevalence of social risk factors in pediatric orthopaedics is underexplored, despite this population's unique vulnerabilities. This study aimed to quantify the prevalence of 5 key social risks, including food insecurity and transportation barriers, and identify associated demographic characteristics in a large pediatric orthopaedic cohort.
Methods:
A retrospective cohort study was conducted on patients over a 2-year period in a large, tertiary-level pediatric orthopaedic clinic. Data were extracted from the electronic medical record, including demographics and responses to systematic screening using the Centers for Medicare and Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool. Five domains were assessed: food insecurity, transportation barriers, social isolation, financial instability, and housing instability. Univariable and multivariable logistic regressions were conducted to evaluate the association between demographic variables and social risk factors.
Results:
A total of 3664 patients were evaluated. Among those screened, 13% reported food insecurity, 4% reported transportation barriers, 22% reported housing instability, 74% reported social isolation, and 14% reported financial insecurity. In adjusted multivariable analyses, identifying as Black was associated with significantly increased odds of transportation barriers (aOR: 2.49, P <0.001), food insecurity (aOR: 2.92, P <0.001), and financial instability risk (aOR: 2.09, P <0.001). Speaking a language other than English was a predictor of risk, particularly for transportation barriers (Spanish aOR: 2.55, P <0.001; Other aOR: 14.10, P =0.01) and financial instability risk (Spanish aOR: 3.30, P <0.001; Other aOR: 5.19, P <0.001). Female patients had significantly lower odds of social isolation (aOR: 0.39, P =0.001) and food insecurity risk (aOR: 0.85, P =0.02) compared with male patients.
Conclusion:
Adverse social determinants are highly prevalent and inequitably distributed within the pediatric orthopaedic population. These findings highlight an urgent need to integrate universal SDOH screening and closed-loop referral pathways into standard orthopaedic practice. Addressing these fundamental social needs is essential for achieving equitable care for all children with musculoskeletal conditions.
Level Of Evidence:
Level III-retrospective cross-sectional study.
