Sociodemographic Determinants of Timely Hip Dysplasia Ultrasound Screening.

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.