Incidence of slipped capital femoral epiphysis is associated with low childhood opportunity index

• Published in: Journal of pediatric orthopaedics. B
• Main Authors: McCoy, Amanda J, Ray, Kristin, Wittman, Samuel, McClincy, Michael
• Format: Journal Article
• Language: English
• Published: United States 29.04.2025
• Subjects: slipped capital femoral epiphysis; social determinants of health; geospatial analysis
• ISSN: 1473-5865
• DOI: 10.1097/BPB.0000000000001258

Slipped capital femoral epiphysis (SCFE) has historically been associated with Black race, male gender, and Hispanic ethnicity, obesity, and adverse social determinants of health. The child opportunity index (COI) 2.0 is an aggregate measure by ZIP code of 29 features of communities that can impact the life outcomes of children. We aimed to investigate the relationship between the incidence of SCFE and residential ZIP code COI. We retrospectively queried the surgical database of a tertiary-referral children's hospital in a medium-sized metropolitan area. We identified subjects who underwent index surgical fixation of SCFE over a 12-year period and determined their composite COI. We calculated the incidence rate, stratified by COI, for our metropolitan area. We performed Chi-squared analysis to determine the associations of SCFE chronicity and stability with COI and obesity. We reviewed 426 hips in 389 unique subjects. In the metropolitan area of interest, we identified a total of 244 hips in 220 unique subjects for an annual incidence rate of 4.17 per 100 000 person-years. Communities in the lowest quintile of COI had higher incidence rates (7.1), while communities in the highest quintile of COI had lower incidence rates of SCFE (2.7, P = 0.035), the relative risk of SCFE decreased by 11% (RR = 0.89, 95% confidence interval: 0.76-1.00). We identified a correlation between obesity and chronicity for our general analysis (P = 0.01163) and the metropolitan analysis (P = 0.005143). This study demonstrated an inverse relationship between SCFE incidence and COI at a pediatric tertiary referral center.