Study Overview
A 2026 study published in the European Journal of Pediatrics investigated patterns of primary healthcare use among Danish children and adolescents prior to hospital consultations for spinal disorders. The research, conducted using nationwide registry data, analyzed 46,497 children aged 2–17 years who received their first hospital-based spine-related diagnosis between 2009 and 2022. The study aimed to describe variations in healthcare utilization based on parental spine-related hospital diagnoses, the child’s comorbidity burden, and household income. The authors emphasized that hospital-based spine diagnoses in children often follow significant primary healthcare interactions, but the specific patterns and influencing factors remained understudied.
Methodology and Population
The study employed a nationwide, registry-based cohort design, leveraging data from Denmark’s national healthcare systems. Participants were identified through the Danish National Patient Registry, with inclusion criteria limited to children with their first hospital-based spine-related diagnosis during the study period. Data on healthcare services used in the two years prior to diagnosis were collected, including visits to general practitioners (GPs), chiropractors, physiotherapists, and office-based specialists. The cohort was stratified by age group, parental spine-related diagnoses, comorbidity burden, and household income tertiles. Key demographic details included a median age at diagnosis of 13.5 years, with 56% of participants identifying as female. Household income data were available for 98.5% of the cohort.
Key Findings
Healthcare utilization patterns varied significantly across provider types and subgroups. In the two years before diagnosis, children had a median of 9 GP reimbursement services (interquartile range [IQR] 5–17), compared to 0 chiropractor services (IQR 0–0), 0 physiotherapy services (IQR 0–0), and 0 office-based specialist services (IQR 0–1). Non-GP provider use was highly skewed, with most children having no or minimal services and a smaller subgroup experiencing repeated use. Patterns of healthcare use differed by parental spine-related diagnoses and comorbidity burden, though no clear income-based gradients were observed. Among age groups, children aged 2–6 years had the highest overall healthcare use, primarily driven by GP services, while chiropractor and physiotherapist services were rare across all age groups. The study noted that these patterns may reflect variations in healthcare needs, particularly during adolescence, when musculoskeletal symptoms are more prevalent.
Limitations and Context
The authors acknowledged several limitations. The study focused exclusively on children with hospital-based spine-related diagnoses, which may not represent all children with spinal pain, as hospital access in Denmark typically requires a primary care referral or emergency department visit. This could mean the cohort includes children with more persistent or complex symptoms. Additionally, the study captured all-cause healthcare utilization, so reimbursement services could not be definitively linked to spinal symptoms. The researchers also noted that the observed healthcare use patterns might reflect broader health needs beyond spinal conditions. Due to these factors, the findings may not be generalizable to the broader pediatric population.
Conclusion
The study highlights the heterogeneity of primary healthcare use among Danish children with hospital-diagnosed spinal disorders. While GP services were consistently the most common, non-GP provider use, including chiropractic and physiotherapy, remained infrequent. Higher healthcare utilization was observed among children with parental spine-related diagnoses and greater comorbidity burdens. However, most children had minimal or no reimbursement for non-GP services. The authors emphasized that these findings reflect a population with complex healthcare needs, though further research is needed to clarify the relationship between primary care interactions and spinal disorder progression.