Variations in the prevalence of scoliosis by age, sex, geographic region, and subtype among Chinese children: A systematic review and modelling study.

Background: Scoliosis is a prevalent spinal condition typically detected in children, yet its prevalence in China has not been fully understood. This study aimed to estimate the prevalence of scoliosis among Chinese children and explore its variations by age, sex, geographic region, and subtype. Methods: We conducted a comprehensive search of seven bibliographic databases to identify epidemiological studies that reported the prevalence of scoliosis among Chinese children published since 1990. Scoliosis was defined as a Cobb angle equal to or greater than 10°, as detected radiographically. We used a multilevel mixed-effect meta-regression to estimate the age- and sex-specific prevalence of idiopathic scoliosis (IS). The overall prevalence and total cases of IS among Chinese children aged 5-18 years in 2020 were generated by applying the China census data. A random-effects meta-analysis was conducted to estimate the pooled prevalence of IS with varying curvatures (10-19°, 20-39°, and ≥40°) and locations (thoracic curve, lumbar curve, thoracolumbar curve, and double curve), as well as congenital scoliosis (CS). Results: A total of 46 articles covering 1 112 163 Chinese children were included. The prevalence of IS ranged from 0.06% (95% confidence interval (CI) = 0.00-0.26) among children aged five years to 1.44% (95% CI = 0.89-2.13) among those aged 18 years, peaking at 1.79% (95% CI = 1.18-2.53) among those aged 16 years. In 2020, the overall prevalence of IS among Chinese children aged 5-18 was 0.79% (95% CI = 0.45-1.27), translating to an estimated 1.81 million (95% CI = 1.04-2.91) affected children. Notably, IS prevalence was nearly double in girls compared to boys (1.03%, 95% CI = 0.63-1.57 vs. 0.58%, 95% CI = 0.29-1.01). Among the six geographic regions, the prevalence of IS was the highest in Northwest China (1.54%, 95% CI = 0.75-2.65) and the lowest in North China (0.33%, 95% CI = 0.11-0.73). The most commonly identified IS subtypes were curvatures of 10-19° and thoracolumbar curves, with a pooled prevalence of 7.14‰ (95% CI = 3.44-12.15) and 2.00‰ (95% CI = 0.83-3.65), respectively. As for CS, the pooled prevalence was 3.03 per 10 000 (95% CI = 1.88-4.43). Conclusions: The prevalence of scoliosis among Chinese children exhibits considerable variations across age, sex, geographic regions, and subtypes. It is imperative to develop targeted public health strategies and optimise the allocation of regional health resources. High-quality epidemiological research is still needed to unmask the diverse burden of scoliosis in children. Registration: PROSPERO CRD42023406260.