Scoliosis among children in Qinghai-Tibetan Plateau of China: A cross-sectional epidemiological study
Lijin Zhou, Honghao Yang, Yong Hai, Junrui Jonathan Hai, Yunzhong Cheng, Peng Yin, Jincai Yang, Yangpu Zhang, Yunsheng Wang, Yiqi Zhang, Bo Han
Abstract
Background The average altitude of Qinghai-Tibetan Plateau is 4,500 m and most of the residents are Tibetan ethnicity. The purpose of this study was to investigate the prevalence of scoliosis and associated factors among children in this region through a scoliosis screening program. Methods A cross-sectional study was preformed between May 2020 and December 2020 in Qinghai-Tibetan Plateau. A total of 9,856 children aged 6–17 years from schools and nearby villages were screened using visual inspection, the Adams forward-bending test, the angle of trunk rotation, and radiography. A self-designed questionnaire was used to collect demographic data. The prevalence of scoliosis and associated factors were analyzed. Results The overall prevalence of scoliosis among children in Qinghai-Tibetan Plateau was 3.69%, with 5.38% for females and 2.11% for males. The prevalence of scoliosis was 3.50% in children resided below 4,500 m while 5.63% in those resided above 4,500 m ( P = 0.001). The prevalence of congenital scoliosis (2.14 vs. 0.42%, P < 0.001) and neuromuscular scoliosis (0.34 vs. 0.07%, P = 0.041) were significantly higher in the altitude above 4,500 m. 50.00% of patients resided above 4,500 m were recommended for surgery while 16.24% in those resided below 4,500 m ( P < 0.001). Independent associated factors were detected as female (OR = 2.217, 95 CI% 1.746–2.814, P < 0.001), BMI < 18.5 (OR = 1.767, 95 CI% 1.441–2.430, P = 0.005), altitude of residence ≥ 4,500 m (OR = 1.808, 95 CI% 1.325–2.483, P = 0.002), and sleep time < 8 h (OR = 2.264, 95 CI% 1.723–2.846, P = 0.001). Conclusion The prevalence of scoliosis among children in Qinghai-Tibetan Plateau was 3.69%. With increasing altitudes, the prevalence of scoliosis and its major type were different from that at lower altitudes. Female, BMI < 18.5, altitude of residence ≥ 4,500 m, and sleep time < 8 h were independently associated with the prevalence of this disease. Early screening should be carried out before the age of 7 years, especially in the high-altitude, underdeveloped, and rural areas.