Erica Yan Ping Po, Meicheng Yang, Naomi Takemura, Jason Pui Yin Cheung, Kenneth Man Chee Cheung, Kris Yuet Wan Lok, Daniel Yee Tak Fong
The updated global prevalence of clinically significant AIS (Cobb angle ≥20°) was 0.28%, associated with environmental (such as temperature) and methodological factors (screening personnel, technique). These findings highlight the complex, multifactorial nature of AIS, underscoring the need for epidemiological surveillance and further assessment of screening strategies to optimize early detection and treatment of AIS worldwide.
STUDY DESIGN: Systematic review and meta-analysis.
OBJECTIVE: To provide an updated global estimate of adolescent idiopathic scoliosis (AIS) prevalence, and to investigate its association with socioeconomic and environmental factors.
SUMMARY OF BACKGROUND DATA: AIS, a common spinal deformity in adolescents aged 10 to 19, with unclear aetiology, limits early diagnosis and prevention. Current global estimates of AIS prevalence require updating, and studies investigating the association with socioeconomic and environmental factors are limited.
METHODS: We systematically searched PubMed, Embase, Scopus, CINAHL, and Web of Science from inception to March 2025, without language restrictions. We included studies with radiographically confirmed AIS in adolescents aged 10 to 19 years. Pooled prevalence estimates for Cobb angles ≥10° and ≥20° were calculated using random-effects meta-analysis. Multivariable meta-regression was employed to explore associated factors.
RESULTS: From 57,701 records, 104 studies encompassing 5.4 million adolescents from 33 countries across six World Health Organization regions were included. The pooled prevalence was 1.26% (95% CI: 1.03 to 1.55) for Cobb angle ≥10°, and 0.28% (95% CI: 0.23 to 0.34) for Cobb angle ≥20°. For curves ≥20°, multivariable meta-regression revealed that higher annual mean surface air temperature (odds ratio [OR]=1.03; P=0.043), screening not involving orthopaedic surgeons (OR=2.04; P=0.003), and higher study quality (OR=1.40; P=0.010) were significantly associated with a higher prevalence. Using the forward bending test alone (OR=0.64; P=0.034) was associated with a lower prevalence.
CONCLUSION: The updated global prevalence of clinically significant AIS (Cobb angle ≥20°) was 0.28%, associated with environmental (such as temperature) and methodological factors (screening personnel, technique). These findings highlight the complex, multifactorial nature of AIS, underscoring the need for epidemiological surveillance and further assessment of screening strategies to optimize early detection and treatment of AIS worldwide.