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Sociodemographic Determinants of Timely Hip Dysplasia Ultrasound Screening
CeAnn Romanaggi1, Julianna Mazziotti1, Spencer Smith1
1Department of Orhtopedics, Oregon Health & Science University, Portland, OR, USA.
Insights
Breech presentation increases risk for hip dysplasia. Sociodemographic factors like maternal insurance and infant ethnicity impact timely ultrasound screening, with 21% of infants missing screening altogether.
Area of Science:
- Pediatric Orthopedics
- Public Health
- Health Disparities
Background:
- Breech presentation is a significant risk factor for developmental dysplasia of the hip (DDH).
- Late diagnosis of DDH can lead to adverse outcomes.
- Current guidelines recommend hip ultrasound (US) screening for breech-born infants at 6 weeks or pelvic radiography at 6 months for early detection.
Purpose of the Study:
- To investigate sociodemographic factors influencing delayed or missed US screening in breech-born infants.
- To identify disparities in screening adherence.
- To inform targeted interventions for equitable DDH screening.
Main Methods:
- Retrospective cohort study of breech-born infants (2008-2023).
- Extracted sociodemographic variables and US screening timing from electronic health records.
- Categorized screening as timely (4-8 weeks), delayed, or missed.
Main Results:
- Only 51% of infants received timely US screening; 21% received no screening.
- Infant ethnicity, maternal marital status, insurance type, and Area Deprivation Index (ADI) were associated with screening timeliness.
- Multivariate analysis confirmed these sociodemographic factors reduce the likelihood of adherent screening.
Conclusions:
- Despite recommendations, a significant proportion of breech-born infants experience delayed or missed DDH screening.
- Maternal and infant sociodemographic characteristics are key determinants of screening disparities.
- System-level changes addressing social determinants of health are crucial for equitable DDH screening and outcomes.
Background:
Breech presentation is a strong risk factor for developmental dysplasia of the hip (DDH), a condition that, when diagnosed late, can lead to poor outcomes. Accordingly, it is recommended that breech-born infants undergo hip ultrasound (US) screening at 6 weeks or receive an anteriorpostierior (AP) pelvic radiograph at 6 months of age to enable early detection and timely intervention. Research evaluating guideline adherence and the factors influencing screening outcomes remain limited. In this study, we investigate sociodemographic factors that influence delayed or missed US screening among breech-born infants.
Methods:
An institutional review board-approved, retrospective cohort study of breech-born infants between 2008 and 2023 at a single institution was conducted. Sociodemographic variables as well as presence and/or timing of US screening were extracted from electronic health records. Screening outcomes were categorized by US timing: (1) screened between 4 and 8 weeks (defined as adherent), (2) screened outside this window, or (3) not screened. Comparisons were performed across groups.
Results:
Two hundred fifty-four infants were born breech and met eligibility criteria. Fifty-one percent underwent "timely" screening, 28% were screened outside the recommended window, and 21% had no screening at all. Univariate analysis demonstrated that infant ethnicity, maternal marital status, insurance type, and Area Deprivation Index (ADI) were significantly associated with screening timeliness. In multivariate analyses, infant ethnicity, as well as maternal insurance type, marital status, and ADI were associated with reduced likelihood of adherent screening.
Conclusions:
Despite the recommended US screening at 6 weeks of age for infants with select risk factors for DDH, half of infants were screened in a timely fashion, while 1 in 5 infants were not screened at all. Several maternal sociodemographic characteristics were associated with untimely or lack of screening. Addressing these factors through targeted interventions is critical to reduce disparities in early identification, timely treatment, and DDH outcomes overall.
Key Concepts:
(1)Fifty-one percent of breech-born infants received a screening ultrasound that was adherent to guidelines.(2)Twenty-one percent of the population for whom screening was recommended did not receive screening at all.(3)Screening completion and timeliness is impacted by maternal marital status, insurance type, and area deprivation index, as well as infant ethnicity.(4)More equitable screening outcomes for developmental dysplasia of the hip will require system-level changes, driven by the collaboration of specialists and primary care providers, which address the social determinants of health.
Level Of Evidence:
Level III, Retrospective Cohort.
