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Child Opportunity Index 3.0 and Insurance Type Do Not Impact Timely Access to Surgery for Pediatric Osteochondral
Ofir Horovitz1, Edmund Corcoran, Mohamed Said
1Department of Orthopaedic Surgery, Division of Pediatric Orthopaedic Surgery, Bronx, NY.
Insights
Socioeconomic status and insurance type did not affect access to knee osteochondral defect care in a pediatric cohort. Delays in care did not impact lesion severity or return-to-sport outcomes.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Health Services Research
Background:
- Socioeconomic status (SES) and insurance type may influence healthcare access.
- Osteochondral defects (OCDe) of the knee are common in pediatric patients.
- Understanding access barriers is crucial for equitable care delivery.
Purpose of the Study:
- To evaluate the impact of SES (Child Opportunity Index 3.0) and insurance on orthopaedic care access for pediatric knee OCDe.
- To determine if care delays correlate with lesion severity or return-to-sport (RTS) outcomes.
Main Methods:
- Retrospective cohort study of 109 pediatric patients with knee OCDe undergoing surgery (2012-2023).
- Analysis of SES using Child Opportunity Index (COI) 3.0 and insurance type.
- Categorization of time to care as prompt (≤30 days) or delayed (>30 days).
Main Results:
- The cohort was predominantly male, Hispanic/Latino, publicly insured, and resided in low COI neighborhoods.
- No significant association found between insurance type or COI scores and delayed care.
- No differences in lesion severity or RTS outcomes between prompt and delayed care groups.
Conclusions:
- In this disadvantaged pediatric cohort, SES and insurance did not impede access to knee OCDe care.
- Care delays did not affect short-term lesion severity or RTS outcomes.
- Institutional factors may mitigate access barriers in safety-net settings.
Background:
This study aimed to evaluate the impact of socioeconomic status (SES), as measured by Child Opportunity Index (COI) 3.0 and insurance type, on access to orthopaedic care among pediatric patients with osteochondral defects (OCDe) of the knee. A secondary aim was to determine whether delays in care were associated with differences in lesion severity or return-to-sport (RTS) outcomes.
Methods:
We conducted a retrospective cohort study of 109 patients aged 21 years or younger who underwent surgery for knee OCDe between 2012 and 2023 at a tertiary academic center. Demographic and clinical variables were extracted from the chart review. The time interval between injury to diagnosis was categorized as prompt (30 d or fewer) or delayed (more than 30 d). COI 3.0 scores, including total and domain-specific scores for education, health, and SES, were assigned using patient zip codes and stratified into quintiles. χ 2 and the Fisher exact tests were used to assess associations between SES indicators and time to care.
Results:
The cohort (mean age 16.1±2.6 y) was predominantly male (64.2%), Spanish/Hispanic/Latino (52.6%), and publicly insured (62.0%), with 75.2% residing in low or very low total COI neighborhoods. Neither insurance type nor COI scores were associated with delayed care. There were also no significant differences in lesion size, ligament injury, or RTS outcomes between prompt and delayed groups at an average follow-up of ∼1.5 years.
Conclusions:
In this predominantly minority and socioeconomically disadvantaged cohort, neither lower COI scores nor public insurance were associated with delayed orthopaedic care for OCDe of the knee. Delays in care did not impact lesion severity or short-term RTS outcomes. Institutional and community-level factors may have mitigated traditional barriers to access in this safety-net pediatric setting.
Level Of Evidence:
Level III.
