O2103: Evaluating the Association between the Child Opportunity Index (COI) 2.0 and Insurance Type on Access to Pediatric ACL Reconstruction Care from Socioeconomically Distressed Communities

Background: Patients with ACL injury and public insurance often encounter delays in ACL reconstruction (ACLR) and exhibit a higher incidence of meniscal injuries compared to their counterparts. Socioeconomic status can be assessed using the Child Opportunity Index (COI) 2.0. Social determinants of health can influence the time required to access specialized healthcare services. This study aimed to explore the relationship between COI and insurance type in access to care for pediatric ACLR.

Methods: We completed a retrospective review of 248 pediatric patients at an academic institution, ages 10-21, who underwent a primary ACLR from 2013-2021. Demographics and clinical data were recorded, including zip code and insurance type. Several time intervals were calculated, such as from date of injury to date of initial orthopedic visit, date of initial orthopedic visit to MRI study date, and MRI study date to date of surgery. Subgroup analysis of patients diagnosed at ≤ 30 days and > 30 days was performed. Statewide COI scores (total, 3 domains) were recorded for each zip code, as well as quintile-ranking categorical scores (very low, low, moderate, high, very high).

Results: A total of 248 patients were included in this study. Mean age was 16.53±1.72, with 66.9% (166) being male. 63% (155) had public insurance, 35% (88) had private insurance. 87.5% (217) had very low or low COI socioeconomic scores. There was no difference in sex, insurance type, Total-COI, Education-COI, Socioeconomic-COI, and Health-COI for patients who had an orthopedic visit ≤ 30 days and > 30 days after injury, who received an MRI ≤ 30 days and >30 days after initial visit, and patients who had surgery ≤ 30 days versus >30 days after MRI study date. Table 1

Conclusion: Our study results suggest that there is no significant difference in sex, insurance type, and COI among patients that delayed or did not delay their surgery. Further research is required to understand if socioeconomic status, as measured by the COI index, is associated with different patient-reported outcomes in the context of primary ACL reconstruction. Even though our study found equity in healthcare access between private versus public insurance patients, there were still a reasonable number of delayed surgeries. This warrants further investigation on identifying specific points in the patient care continuum that contribute to delayed surgery, particularly in individuals with lower COI scores. Furthermore, investigating the effectiveness of community-based interventions in promoting health equity among children with ACL injuries is essential.