Screening for DDH: The Impact of Socioeconomic Factors Before and After the COVID-19 Pandemic

Screening programs are vital for timely treatment of developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate the effect of patient demographics on time to screening for DDH pre- and post-COVID-19.

This was a retrospective review of patients presenting for DDH screening between January 2018 and December 2022. Patients were categorized into 3 time period groups, Time 1 (pre-COVID), Time 2 (time period in which COVID restrictions were applied in our catchment area), Time 3 (post-COVID restrictions). Patients over age 7 years and with non-idiopathic diagnoses were excluded. Area Deprivation Index (ADI) was derived from patients' home zip code. Age at screening was evaluated in relation to demographic factors using Spearman's rho and Mann-Whitney U or Kruskal Wallis H tests.

2175 patients were included. Age at presentation was increased in Time 3 compared to Times 1&2 (Time 1: 5.4±7.6 mo, Time 2: 5.2±6.4 mo, Time 3: 6.4±8.1 mo P <0.001). Public insurance was a risk factor for delayed presentation in all 3 time periods but was amplified in Time 3 (Times 1&2: 1.9 mo difference, P <0.001; Time 3: 2.3 mo difference, P <0.001). Similarly, ADI was a risk factor for delayed presentation in all 3 time periods but was magnified in Time 3 (Time 1: ADI national r s =0.078, P =0.043, ADI state r s =0.082, P =0.032; Time 2: ADI national r s =0.097, P =0.035, ADI state r s =0.094, P =0.04; Time 3: ADI national r s =0.14, P <0.001, ADI state r s =0.137, P <0.001).

Public insurance status is correlated with delays in DDH screening. COVID-19 widened the gap between publicly and privately insured patients and magnified the effects of negative social determinants of health regarding timely musculoskeletal care for patients at risk for DDH.