Abstract
INTRODUCTION: Synthesised data on the global prevalence of scoliosis in children and adolescents and its associated risk factors remain scarce. This systematic review aimed to estimate the global prevalence of scoliosis in children and adolescents and identify associated risk factors in children and adolescents. METHODS: We conducted a systematic review and meta-analysis, searching nine electronic databases for observational population-based studies on scoliosis in children and adolescents published until June 02, 2024, without language or geographical restrictions. We estimated the global prevalence using the DerSimonian-Laird random-effects model with Free-Tukey double arcsine transformation and stratified prevalence through prespecified subgroup analyses. Fixed-effects models were used for consistent risk factors across studies, while random-effects models were applied for factors with high heterogeneity. RESULTS: We initially identified 12,339 records, of which 239 studies comprising 46,565,512 participants were included. The estimated global prevalence of scoliosis in children and adolescents was 1.65% (95% CI 1.38-1.94), varying from 0.05% in Ecuador to 16.67% in Romania. We found higher prevalence in European (2.88%) and Americas (2.54%) than other regions (Eastern Mediterranean 1.22%, South-East Asia 1.35%, Western Pacific 1.35%, and African 1.46%). The higher prevalence was in high-latitude regions (2.96% vs mid-latitude 1.62% vs low-latitude 1.73%). The prevalence in girls was nearly double that in boys (1.76% vs 0.87%), with a steady increase observed from ages 7 to 16 years, peaking at 12-14 years for girls and 15-16 years for boys. The prevalence in adolescents (10-18 years) was nearly four times higher than that in children (6-9 years) (1.13% vs 0.26%). Idiopathic scoliosis in children and adolescents constituted the majority of cases, predominantly presenting as mild scoliosis (Cobb angle 10°-19°, 86.65%) with the single thoracolumbar curve being the most common subtype (36.67%). Additionally, the prevalence may increase since 2020 year (3.02%). Scoliosis in children and adolescents was significantly associated with sex (girls, odds ratio 2.16, 95% CI 2.01-2.33), family history (1.92, 95% CI 1.47-2.50), sedentary behavior (≥ 11 h, 1.64, 95% CI 1.20-2.25), poor sitting posture (3.48, 95% CI 2.85-4.24), short outdoor time (< 1 h, 1.32, 95% CI 1.10-1.59), long screen time (≥ 2 h, 2.74, 95% CI 2.29-3.28), unilateral physical activity (1.36, 95% CI 1.20-1.55), and low BMI (1.15, 95% CI 1.08-1.22). CONCLUSIONS: Scoliosis in children and adolescents remains highly prevalent globally. Our findings can help to guide epidemiological characteristics and development of tailored preventive and therapeutic strategies, ultimately enhancing primary prevention and controlling disease progression. TRIAL REGISTRATION: CRD42024584704.