School-based scoliosis screening among 73,509 students in Zhangye, Northwest China: epidemiological characteristics, 7-day non-completion in the radiographic diagnostic cascade, and an exploratory case–control analysis
4 affiliations
- 1School of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine
- 2Department of Spinal Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine
- 3School of Public Health, Suzhou Medical College of Soochow University
- 4School of Clinical Chinese Medicine, Gansu University of Chinese Medicine
Abstract
Background: School scoliosis screening is effective only when students who screen positive complete diagnostic confirmation. We described a citywide program in Zhangye, Northwest China, quantified 7-day non-completion in the radiographic diagnostic cascade, and explored characteristics associated with adolescent idiopathic scoliosis (AIS) case status.
Methods: From September to October 2025, all 66 primary and secondary schools in Zhangye City participated. Students aged 10–18 years underwent postural inspection, the Adams forward bend test, and angle of trunk rotation (ATR) measurement. ATR > =5 degrees defined a screening-positive result. Screening-positive students were advised to undergo standing full-length spine radiography within 7 days. Two experienced spine surgeons, blinded to ATR results, independently measured the maximum Cobb angle; their mean was used. AIS required a mean Cobb angle ≥ 10 degrees and exclusion of known secondary causes. We analyzed the screening population, diagnostic cascade, and an unmatched exploratory case–control sample of 250 AIS cases and 250 screening-negative controls using multivariable logistic regression.
Results: Among 73,509 students, 1,451 screened positive (1.97%, 95% CI 1.88–2.08). The rate was higher in girls than boys (2.59% vs. 1.49%), increased after age 12, and ranged from 1.50 to 3.08% across counties/districts. Only 348 screening-positive students completed radiography within 7 days (23.98%, 95% CI 21.86–26.25); 1,103 had no recorded completion within this window (76.02%, 95% CI 73.75–78.14) reflecting 7-day non-completion rather than permanent non-completion. Among those imaged, 250 had a mean Cobb angle ≥ 10 degrees and were diagnosed with AIS, representing 71.84% (95% CI 66.89–76.31) of those imaged and a minimum confirmed detection proportion of 0.34% (95% CI 0.30–0.38) among all screened students. In the complete-case model ( n = 452), female sex, increasing age, sometimes rather than frequently maintaining an upright classroom posture, and left-side rather than supine sleeping were associated with AIS case status; BMI was not independently associated.
Conclusion: The principal implementation gap occurred between screening-positive identification and timely radiographic confirmation. The 0.34% proportion is a minimum confirmed detection estimate, not population prevalence. Closed-loop referral pathways are needed, and the exploratory case–control associations should not be interpreted causally.
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BibTeX
@article{yang2026schoolbased,
title = {{School-based scoliosis screening among 73,509 students in Zhangye, Northwest China: epidemiological characteristics, 7-day non-completion in the radiographic diagnostic cascade, and an exploratory case–control analysis}},
author = {Shaobo Yang and Juan Wang and Jie Tan and Xiaoyun Yuan and Changquan Dai and Yanxiang Zhang and Liyang Luo and Dong Hou and Jiao Li and Xiaole Zhu and Jianjun Duan and Jin Huang and Chen Zhang and Jiantao Wen},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1943469},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1943469/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - School-based scoliosis screening among 73,509 students in Zhangye, Northwest China: epidemiological characteristics, 7-day non-completion in the radiographic diagnostic cascade, and an exploratory case–control analysis
AU - Shaobo Yang
AU - Juan Wang
AU - Jie Tan
AU - Xiaoyun Yuan
AU - Changquan Dai
AU - Yanxiang Zhang
AU - Liyang Luo
AU - Dong Hou
AU - Jiao Li
AU - Xiaole Zhu
AU - Jianjun Duan
AU - Jin Huang
AU - Chen Zhang
AU - Jiantao Wen
PY - 2026
DA - 2026/11/04
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1943469
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1943469/full
AB - Background: School scoliosis screening is effective only when students who screen positive complete diagnostic confirmation. We described a citywide program in Zhangye, Northwest China, quantified 7-day non-completion in the radiographic diagnostic cascade, and explored characteristics associated with adolescent idiopathic scoliosis (AIS) case status. Methods: From September to October 2025, all 66 primary and secondary schools in Zhangye City participated. Students aged 10–18 years underwent postural inspection, the Adams forward bend test, and angle of trunk rotation (ATR) measurement. ATR > =5 degrees defined a screening-positive result. Screening-positive students were advised to undergo standing full-length spine radiography within 7 days. Two experienced spine surgeons, blinded to ATR results, independently measured the maximum Cobb angle; their mean was used. AIS required a mean Cobb angle ≥ 10 degrees and exclusion of known secondary causes. We analyzed the screening population, diagnostic cascade, and an unmatched exploratory case–control sample of 250 AIS cases and 250 screening-negative controls using multivariable logistic regression. Results: Among 73,509 students, 1,451 screened positive (1.97%, 95% CI 1.88–2.08). The rate was higher in girls than boys (2.59% vs. 1.49%), increased after age 12, and ranged from 1.50 to 3.08% across counties/districts. Only 348 screening-positive students completed radiography within 7 days (23.98%, 95% CI 21.86–26.25); 1,103 had no recorded completion within this window (76.02%, 95% CI 73.75–78.14) reflecting 7-day non-completion rather than permanent non-completion. Among those imaged, 250 had a mean Cobb angle ≥ 10 degrees and were diagnosed with AIS, representing 71.84% (95% CI 66.89–76.31) of those imaged and a minimum confirmed detection proportion of 0.34% (95% CI 0.30–0.38) among all screened students. In the complete-case model ( n = 452), female sex, increasing age, sometimes rather than frequently maintaining an upright classroom posture, and left-side rather than supine sleeping were associated with AIS case status; BMI was not independently associated. Conclusion: The principal implementation gap occurred between screening-positive identification and timely radiographic confirmation. The 0.34% proportion is a minimum confirmed detection estimate, not population prevalence. Closed-loop referral pathways are needed, and the exploratory case–control associations should not be interpreted causally.
SN - 2296-2565
ER -