The influence of health policy on early diagnosis and surgical incidence of developmental dysplasia of the hip

Background Hip screening is the standard approach for the early detection of developmental dysplasia of the hip (DDH). However, there is a lack of evidence regarding the effects of national policy on early diagnosis and later surgical incidence. The purpose of this national study is to estimate DDH incidence in the Taiwanese population through a new diagnosis definition and to examine whether a health promotion policy could reduce surgeries for DDH. Methods and results Six birth-year cohorts (2000 +/- 2005) were evaluated for DDH diagnosis and related surgeries using the database of the National Health Insurance Administration, which covers 99% of the population of Taiwan. Children with three or more sequential International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (754.3x) in the outpatient claim file or DDH-related surgeries were studied. The outcome of hip screening was evaluated with the ratio of early diagnosis (0 +/- 6 months) to late diagnosis (1 +/- 5 years) and the incidence of major surgeries for DDH. DDH incidence was 1.54 per thousand live births (2,255/1,462,539). After a hip screening promotion policy was implemented in 2002, ratios of early/late diagnosis increased from 1.06, 1.25, 1.38, and 1.5 to 1.75 for the years 2000 to 2005, respectively. Incidences of major surgery decreased from 0.41 +/- 0.47 per thousand before policy administration to 0.33 +/- 0.37 per thousand after policy administration. Discussion The DDH incidence of 1.54 per 1,000 in a geographically well-defined area offered epidemiological data for further studies in Asian populations. The results suggest that the health promotion policy is associated with an increase in early diagnosis and subsequently a decrease in surgeries for DDH.