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Positive rate and influencing factors of adolescent idiopathic scoliosis among school children aged 9 to 18 years in Xiamen, China

BMC Pediatrics volume 25, Article number: 216 (2025) Cite this article

Abstract

Objective

The present study aimed to investigate the positive rate of adolescent idiopathic scoliosis (AIS) among school children in Xiamen, Fujian province, China, and evaluate its possible risk factors.

Methods

The study was a school-based, cross-sectional scoliosis screening program in Xiamen city. A total of 19,315 school children aged 9–18 years in Xiamen were recruited using a multistage sampling approach. Scoliosis screening was performed through visual inspection of clinical signs, Adams forward bending test, and measurement of trunk rotation angles using a scoliometer. Demographic data, clinical characteristics, and behavioral factors were collected using a questionnaire, and logistic regression analysis was conducted to analyze the possible risk factors.

Results

The overall positive rate of AIS among school children was 7.12%. Among underweight students, 10.36% were confirmed to have a positive diagnosis of AIS. Multivariable logistic regression models demonstrated age and sex (AOR: 5.00, 95% CI: 4.33–5.76) were associated with AIS. Girls who had experienced menarche (AOR: 1.39, 95% CI: 1.10–1.77) had a higher risk of developing AIS. Students with low body mass index (BMI) (AOR: 1.75, 95% CI: 1.39–2.19), insufficient sleep duration (AOR: 1.67, 95% CI: 1.45–1.93), and carrying single-shoulder bags (AOR: 2.73, 95% CI: 2.38–3.13) were more likely to develop AIS.

Discussion

The positive rate of AIS among school children in Xiamen was 7.12%. Older age, girls, low BMI, insufficient sleep duration, and carrying single-shoulder bags were risk factors for AIS.

Peer Review reports

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine with a coronal curvature of more than 10 degrees, that arises in otherwise healthy children around puberty [1]. The reported prevalence of AIS varies widely from 0.13 to 13%, depending on the defined instrument employed, Cobb angle, and screening age [2,3,4]. In addition, different regions and ethnicities may contribute to variations in the prevalence rate [5, 6]. A higher prevalence of AIS is found in northern geographic latitudes and lower in countries close to the equator [7]. In 2019, the detection rate of abnormal spinal curvature among Chinese primary and secondary school students was 2.8% [8]. The results of some scoliosis screening programs showed the estimated prevalence of AIS was 2.4% [9] in Wuxi and 5.14% in Guangdong province, China [10]. Mild or moderate AIS is usually asymptomatic and is neglected by primary health professionals. If left undetected and untreated, it can lead to progressive scoliosis with worsening deformity and pain, and surgery is often required at an advanced stage [11]. Therefore, early screening is necessary to enable early intervention and to prevent disease progression.

School scoliosis screening (SSS) has been regarded as a powerful method to identify adolescents with scoliosis as well as those at high risk for the disease [12, 13]. SSS includes different types of assessment methods. The Adams forward bending test (FBT) and the angle of trunk rotation (ATR) measurement are the most commonly used assessment methods in identifying patients with AIS due to their acceptable sensitivity (71.1%) and specificity (97.1%) [14]. Moreover, these methods are not involved in radiography and there are no concerns about the radiation harm. Therefore, many previous studies have used the combination of FBT and ATR measurement to conduct SSS studies, such as a survey on the prevalence of scoliosis carried out by Zou et al. [15] in Zhejiang province, China, as well as an investigation on influencing factors of IS conducted by Tahirbegolli et al. [16] in Kosovo.

Although the etiology of AIS remains unknown, numerous hypotheses have been proposed, including genetic factors, endocrine abnormalities, and nervous system dysfunction [17]. Adolescents experience critical periods of rapid physical growth and are vulnerable to AIS owing to skeletal immaturity [18]. Menarche is a commonly used, readily identifiable maturity indicator in girls, reflecting the remaining growth potential and reliably associated with decelerated growth velocity [19]. Mao et al. [20] found a higher likelihood of delayed onset of menarche in AIS girls. However, Penha et al. [21]. found that the occurrence of AIS and the type of curve were not associated with the occurrence of menarche or the age at which menarche occurred. Similarly, the first spermatorrhea in boys is commonly used as a marker of sexual maturity, indicating the later stages of puberty [22]. However, there is a limited number of studies analyzing the relationship between indicators of male maturity and AIS, possibly due to the scarcity of male cases. Various hormones, especially estrogens may act on bone metabolism and interact with factors modulating the growth, biomechanics, and structure of bone in adolescence [23]. Therefore, it is not surprising that a higher prevalence of AIS is observed in girls. The predicted sex ratio of girls to boys was 5:1 for children aged 6 to 13 years [24], and even as high as 11:1 for those aged 11 to 14 years in Ueno et al.’s study [25]. Low body mass index (BMI) is associated with an increased risk of AIS. The risk of developing scoliosis in adolescents with low BMI was 1.43 times higher than that in those with normal BMI [26]. Furthermore, low BMI is correlated with deformity severity. More severe spinal deformities were found among adolescents with low BMI than among those in the other BMI groups [27].

Adolescent lifestyle behaviors have a significant impact on their physical and psychological development [28]. Several studies have analyzed the relationship between lifestyle behaviors and the risk of AIS. A shorter sleep duration was found to be associated with an increased risk of AIS. The risk of IS in people with less than 8 h of sleep is 3.33 times higher than in those with more than 10 h of sleep [29]. A chronically incorrect sitting posture [30], carrying overweight backpacks, and the use of single-shoulder bags [31] were also found to be AIS predictors in previous studies. However, in a study conducted by Watanabe K et al. [32], no correlation was found between daily lifestyle habits and AIS.

Although some studies have been conducted in Wuxi and Shenzhen in China to investigate the prevalence of AIS and its risk factors, the small number of AIS cases or regionality limited the generalizability and comparability of the findings to Fujian province which is located in the southeast of China at 24 degrees north latitude. The present study aimed to investigate the positive rate of adolescent idiopathic scoliosis among school children in Xiamen, Fujian province, and evaluate its possible risk factors. This may provide information for identifying high-risk individuals and implementing preventive measures for AIS.

Methods

Participants

The sample size was calculated using the following formula: \(\:n=\frac{{u}_{\alpha\:}^{2}\:p(1-p)}{{d}^{2}}\) [29]. Where p is the prevalence of AIS, which has been reported to be approximately 5% according to Fan et al.’s study [10]; d is the sensitivity level (margin error), d=0.15p; u0.05= 1.96. Considering a 10% non-response rate, the minimum sample size was calculated to be 3,604.

The school-based cross-sectional study was performed in Xiamen between November 2020 and December 2022. The study participants were recruited using a multistage sampling approach. A total of 72 schools including 24 primary and 48 secondary schools, were selected using the method of probability proportional to size. Each class in every grade at the selected school was assigned a unique serial number. Subsequently, the classes were screened according to the random number created by the computer. Two classes were then randomly sampled from each grade at the selected school. All students in the recruited classes were included in the study. At least 80 students in each grade were selected. Students aged over 9 years were eligible to participate in the study. Students who were unable to perform Adam’s forward bending test due to any reasonable cause or those who had congenital or other scoliosis secondary to identifiable etiologies were excluded. A total of 87 participants were excluded, including 51 participants with incomplete data and 36 who were not able to perform forward flexion tests due to disability or other reasons. Finally, 19,315 students aged 9–18 years were recruited for the study.

The data were collected at October to November 2020, November to December 2021, and November to December 2022, respectively. The data collection was conducted from October to December in each year to avoid the possible influences of seasons. During the period, the average temperature of Xiamen is about 20℃, which is suitable for physical examination. And from September 2020, schools of Xiamen got back to normal. Only in the first half-year of 2020, the class was suspended for two months because of pandemic. Considering the slow development of AIS, the pandemic-related factors may not significantly impact the results.

This study was approved by the Ethics Committee of the Xiamen Center for Disease Control and Prevention (XJKLLSC2024017). The students participating in the screening and their parents or guardians were informed of the purpose and procedure of the study, and their informed consent was obtained.

School scoliosis screening

The AIS screening program followed the standardized National Health Service protocol [10]. Scoliosis screening was performed at the school. The methods of visual inspection of clinical signs, FBT, and measurement of the ATR using a scoliometer were employed for screening. Participants were visually inspected in an upright position. The examiner checked for asymmetry in shoulders, spine alignment, hip and pelvic obliquity, and spinous process line tilt. Significant clinical signs were recorded. Thereafter, the FBT was conducted combining with the ATR determination using a scoliometer conducted. The participants were directed to slowly bend their upper body forward to 90 degrees, looking down, while maintaining a distance of approximately 15 cm between their feet, extending their knees, relaxing their shoulders, and placing their palms together in front of their knees [21]. The examiner assessed the asymmetry of the back, ribs, and shoulders. Any significant asymmetry indicating thoracic rotation was recorded. The participants then continued to flex their trunks. The ATR value was recorded by positioning the calibrated scoliometer on the spinous processes of the thoracic, thoracolumbar, and lumbar spines, respectively. The examiner stood behind the participant with their eyes at the same level as the instrument to obtain an exact reading. Two measurements were taken, with the participants returning to the upright position after each measurement. The mean of the two values was then recorded [33]. If participants had an ATR of at least 5 degrees or two or more significant asymmetry clinical signs, they were rescreened by a trained orthopedic surgeon. If confirmed upon rescreening, the participant was diagnosed to be positive in AIS. The intrarater reliability regarding ATR degree from the scoliometer was very high, with an intra-class correlation (ICC) of 0.82. All screening examiners were uniformly trained and qualified before participating in scoliosis screening. Each student was screened privately.

Anthropometrical measurement

Height and weight were measured by well-trained investigators using a standardized scale and procedures. The scale was calibrated by a calibration rod and weight with the measurement error at 0.1 cm and 0.1 kg. It was placed on a horizontal hard floor surface. The participants wearing light clothing and no shoes stood in an upright position with heels together. BMI was calculated by dividing body weight in kilograms by height in meters squared. Participants were categorized as underweight, normal weight, overweight, or obesity, based on China’s definition of the nutritional status of children and adolescents [34, 35].

Questionnaire

The standard questionnaire was designed by the Chinese Center for Disease Control and Prevention [36], which exhibited satisfactory reliability and validity in the pilot study with the Cronbach’s Alpha of 0.84. It included demographic characteristics (age, sex, and residence), secondary sexual characteristics (age at menarche and age at first spermatorrhea), and lifestyle factors (sleep duration, sedentary time, frequency of exercise, and use of backpack posture). Face-to-face interviews were conducted by trained investigators. The investigators explained standardized instructions to the participants before they completed the questionnaire. The questionnaires were checked regularly. If any missing information was identified, further information was collected via phone call to the numbers provided by the participants or through one more visit to the participants’ school.

Data on the occurrence and age at menarche (AAM) were collected from girls and categorized into two groups: <12 years and ≥ 12 years old [37]. The occurrence and age at first spermatorrhea were collected from boys, stratified into < 14 and ≥ 14 age groups [38]. Various behavioral factors were also collected, including sleep duration, sedentary time, frequency of exercise, and use of backpack posture. Sleep duration was classified as ≥ 8 h and < 8 h per day. Daily cumulative sedentary time was categorized into ≥ 8 h and < 8 h per day. The frequency of exercise was stratified into three levels based on the times of moderate-to-vigorous intensity exercise for over 60 min per week, which was ≤ 1 time, 2–4 times, and ≥ 5 times per week. Backpack posture was classified into carrying double-shoulder bags, carrying single-shoulder bags, and using bags with wheels.

Statistical analysis

All statistical analyses were performed using IBM SPSS Statistic 25.0. Continuous variables were expressed as median (interquartile range) and categorical variables were expressed as numbers and frequencies. The Chi-square test was used to compare the difference in prevalence of AIS between different groups. Subsequently, univariate logistic regression analysis was used to explore the association between each variable and AIS. The variables with statistical significance in the univariate analysis were included in the multivariate logistic regression model to further explore the association of demographic characteristics and lifestyle with AIS. All P-values were two-tailed and the significance level was set at 0.05.

Results

General characteristics of the participants

A total of 19,315 participants aged 9 to 18 were screened for scoliosis, including 10,196 boys (52.8%) and 9,119 girls (47.2%), as shown in Table 1. Their median age was 13.0 years (11.0, 16.0). The 72.1% girls had menarche and 36.9% boys had experienced their first spermatorrhea. The proportions of underweight, overweight, and obesity among the participants were 5.1%, 17.0%, and 10.8%, respectively.

Table 1 General characteristics of the study participants
Full size table

Positive rate of AIS

The overall positive rate of AIS was 7.12% among the 19,315 students with a higher prevalence among girls than boys (12.26% vs. 2.52%), as shown in Table 2. Girls had a significantly higher positive rate than boys with a sex ratio of 4.86:1. The positive rate increased with age and reached a peak at the ages of 15 and 16 years for girls (14.47%) and at the ages of 17 and 18 years for boys (3.26%). The underweight students had a significantly higher positive rate (10.36%) than that of children with normal (8.31%) and higher BMI (3.84% and 3.32%). There was no significant difference in the positive rates between students from the urban and suburban areas.

Table 2 The positive rate of adolescent idiopathic scoliosis of the participants
Full size table

Factors associated with AIS

As shown in Table 3, univariate logistic regression analysis showed that age, sex, occurrence of menarche, AAM, age at first spermatorrhea, BMI, sleep duration, sedentary time, frequency of exercise, and backpack posture were all related to AIS (all P < 0.05).

Table 3 Univariate and multivariate logistic regression analysis of factors associated with adolescent idiopathic scoliosis
Full size table

In multiple logistic regression analysis, age was found to be directly associated with AIS. Furthermore, it was observed that girls had a higher likelihood of developing AIS (AOR: 5.00, 95% CI: 4.33–5.76). The occurrence of menarche was also identified as an independently associated factor, increasing the risk of AIS by 1.39 times (95% CI: 1.10–1.77). Boy experiencing the first spermatorrhea after 14 years had a lower risk of AIS (AOR: 0.55, 95% CI: 0.37–0.73). Underweight students had 1.75 times (95% CI: 1.39–2.19) higher risk of AIS than those with normal weight. However, overweight (AOR: 0.58, 95% CI: 0.48–0.71) and obese (AOR: 0.52, 95% CI: 0.40–0.66) students had a lower risk of AIS. Those who slept less than 8 h per day had 1.67 times (95 CI% 1.45–1.93) higher risk than those with more than 8 h of sleep per day. Moreover, compared with the students carrying a double-shoulder bag, those who carried a single-shoulder bag had a higher risk of AIS (AOR = 2.73, 95% CI: 2.38–3.13).

Discussion

The current study investigated the positive rate and influencing factors of AIS among school children in Xiamen. The overall positive rate of AIS in school adolescents was 7.12%, which was on the higher spectrum of the global prevalence of adolescents (0.13–13%) [2,3,4]. The positive rate of AIS found in the current study was comparable to that found in a study conducted in Guangdong province (7.93%) [10]. However, different results have been reported in the previous studies. Jundi et al. [21] screened 5.0% positive of AIS from 2,562 adolescents between 10 and 14 years in Brazil. Yılmaz et al. [39] reported a positive rate of 15.9% among 16,045 students aged 10–15 years in Turkey. Potential explanations for the different prevalence in these studies might be the different regionalities and ethnicities. The different cut-off values applied in the studies may also contribute to the variation in the positive rate. The application of a higher cut-off value of ATR ≥ 7° may lead to the underdiagnosis of scoliotic children in Jundi’s study.

Although the FBT combined with the scoliometer is a simple and fast method for identifying the presence of AIS in the school-based screening, its accuracy is the subject of debate [40]. FBT is direct and easy to perform. But this test relies on visual and physical examinations to obtain data, which is susceptible to the subjectivity of screeners. Results could be significantly influenced by personal experience and professional skill of the screeners. Considerable systematic errors may occur due to differences in personal standards in large-scale screening study. The accuracy of the scoliometer is another important factor during the screen. Studies have indicated that the scoliometer becomes more reliable as ATR reading increased. At an ATR reading of 5°, the scoliometer has a sensitivity of approximately 100% and a specificity of 47%. Its sensitivity decreased to 83%, but specificity increased to 86% at an ATR reading of 7°. A recently published large population-based study showed by using a three-stage AIS screening design including FBT and scoliometer, the positive predictive value for diagnosis reached 78.4% at a referral rate of 6.6% [10]. Therefore, clinical effectiveness of AIS screening could be improved by combining the clinical signs judged by professional orthopedic surgeons and multi-stage screening.

We found that age, sex, BMI, sleep duration, backpack posture, and menarche in girls were closely correlated with AIS. Girls were more susceptible to AIS than boys. A higher positive rate of AIS was observed among girls in all age groups, which was consistent with the findings of Wong et al. [4]. As scoliosis is frequently concomitant with decreased estrogen levels and delayed puberty, some researchers postulate that estrogen may play a role in the development of scoliosis [41]. During the later stages of menarche, estrogen depletion reduces osteoblast proliferation and activity that causes osteopenia [42]. Low levels of circulating estrogen also lead to reduced osteoblast differentiation, which affects the structural properties of the bone, including stiffness, elasticity, and strength [23]. Our study further revealed that girls who had experienced menarche had a higher risk of AIS than those who had not. The association between menarche and AIS also implies a role for estrogen in the progression of this disease. In addition to impact of puberty on AIS, the role of gender difference in AIS has to be mentioned. “Carter effect” has been reported to explain the higher prevalence of AIS in females, which suggests that males with AIS would need to inherit a larger number of susceptibility genes compared with females to develop the deformity [43]. Sharma et al. [44] identified a female-specific IS susceptibility locus and hypothesized this locus increased the risk of IS through the interaction of downstream hormones. During puberty, the great difference of physical characteristics between genders potentially affects the sensitivity and specificity of screening. Girls who tend to undergo earlier pubertal development may exhibit more distinct physical characteristics that facilitate detection during screening, while boys with later pubertal development may be under-diagnosed. These differences may produce bias in the screening outcomes. Future research work should incorporate biological and sociological factors to develop more personalized screening protocols, enhancing early and accurate detection of AIS.

Low BMI was found to be a significant risk factor for AIS in our study, which was consistent with previous studies [26, 45]. It has been reported that the IS population had a lower BMI than the general population [46]. Low BMI leads to lower muscle mass and produces negative effects on the stability of the skeletal and muscular systems, which may increase the risk of scoliosis [26]. Furthermore, low BMI was associated with lower circulating leptin levels [47]. Decreased circulating leptin levels may increase the activity of the autonomic nervous system, resulting in a developmental imbalance between the autonomic and somatic nervous systems, and then increasing the risk of spinal deformities [48]. Leptin reduction can also lead to a decrease in bone mineral density (BMD) and bone mineral content [49], which may contribute to the progression of AIS. In addition, our results indicated that overweight and obese subjects had a lower risk of AIS than those with normal BMI. However, Baroni et al. [50] reported that overweight or obese schoolchildren were more likely to develop scoliosis. The difference may contribute to the limitations and lower accuracy of the methods of FBT and ATR measurement in overweight and obese patients because their spine and rib prominences are obscured by the overlying soft tissue [51]. This makes AIS with smaller curves more difficult to screen and diagnose in overweight and obese patients. Once AIS is detected by screening in obese children, the curve may have already been large. This was confirmed by Goodbody et al. [52]. who found a significantly larger amplitude of the curve in overweight and obese adolescent IS patients. Furthermore, schools and primary care offices may consider lowering referral thresholds and establishing alternative screening methods for children with high BMI.

Insufficient sleep may cause significant changes in endocrine, metabolic, immune, and inflammatory systems [53]. In the present study, we found that sleep duration of less than 8 h per day was a risk factor for AIS. A similar result was obtained by Zhou et al. [54]. Longer sleep durations can more effectively alleviate skeletal muscle fatigue caused by spinal scoliosis [29, 50]. Furthermore, decreasing sleep time generates an increase in glucocorticoid levels. Increased glucocorticoid levels can trigger apoptosis in osteoblasts and osteocytes by activation of caspase-3, which leads to a significant reduction in bone formation and low BMD, and may potentially lead to increased spinal curvature [55,56,57]. On the other hand, scoliosis impairs the function of the respiratory system by restricting movement of the chest wall and preventing normal inflation of the lungs [58]. Patients with scoliosis are more likely to experience apnea and hypopnea during sleep, which affects their sleep quality and reduces their actual sleep duration [59].

Postural disequilibrium has been reported to be a contributory etiological factor in AIS [60]. The balance of human standing posture can be influenced by external factors, such as load carriage [31]. Schoolbag is one of the most commonly used tools for students. Schoolchildren use different bag models to carry their books and amenities, such as backpacks, one-shoulder bags, and suitcases with wheels. Our study indicated that students using single-shoulder bags had a higher risk of AIS than those using double-shoulder bags. Carrying a backpack with only one shoulder causes the other shoulder to be elevated, leading to lateral bending of the spine away from the bag [61, 62]. Prolonged use of a backpack in this manner increases asymmetry in the shoulders, scapula, pelvis, and trunk [63]. It was also found that asymmetric carrying can lead to balance disorders in patients with AIS and increase spinal curve progression and pain [31, 64]. Moreover, asymmetric loading may reduce muscle and lower back strength. Due to unbalanced posture and asymmetric loading, scoliosis deteriorates further.

This was the first school-based large-scale project to investigate the positive rate and risk factors of AIS among 9-18 year-old children in Xiamen. Moreover, this study extended the existing literature by establishing relations between the risk of AIS and behavioral factors such as sleep duration and schoolbag carrying patterns. This study contributes to the better understanding of adolescent scoliosis in Xiamen. It is helpful for the local health staffs to identify individuals at high risk of AIS and offer timely interventions. It is crucial in preventing progression of AIS and improving life quality of affected individuals. By emphasizing the importance of age-specific screening and considering regional health disparities, the study may assist policymakers to design more practical and accessible healthcare strategies for adolescents. This could ultimately lead to better health outcomes, reduced healthcare costs, and more efficient use of resources in the prevention and treatment of AIS.

However, this study had several limitations. Firstly, the radiographic examination was not performed immediately. Thus, the false-negative and false-positive rates could not be estimated. Secondly, as this was a cross-sectional study, longitudinal data could not be collected and causality could not be established. Thirdly, our present study was one part of common disease surveillance project for children in Xiamen, including AIS, dental caries and myopia. In the screening survey, it was difficult for us to include too many questions in a questionnaire. So, some important poster-related risk factors of AIS were not included in the questionnaire. Further study should be conducted to evaluate the effect posture and daily behaviors on the development of AIS. In conclusion, Our study found that the positive rate of AIS among school children in Xiamen was 7.12%. Older age, girls, low BMI, insufficient sleep duration, and use of single-shoulder bags were risk factors for AIS.

Data availability

The data and materials may be available upon reasonable request from the corresponding author.

Abbreviations

AIS:

Adolescent idiopathic scoliosis

AOR:

Adjusted odds ratio

CI:

Confidence interval

BMI:

Body mass index

SSS:

School scoliosis screening

FBT:

Forward bending test

ATR:

Angle of trunk rotation

AAM:

Age at menarche

BMD:

Bone mineral density

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Acknowledgements

We thanked all the participants in the experiment.

Funding

This work was funded by the National Funds for Prevention and Control of Major Infectious Diseases, China (Project number: 10000019Z195110010004).

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Author notes

  1. Zhongrui Peng and Yuanchao Li contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Department of Preventive Medicine, National Innovation Platform for Industry-Education Integration in Vaccine Research, Xiamen University, 4221 − 117 Xiang’an Nan Road, Xiamen, 361102, China

    Zhongrui Peng, Yuanchao Li, Hong Yang, Yuqing Li, Mengyang Gao, Guimei Liu, Tianmu Chen & Lei Li

  2. Xiamen Center for Disease Control and Prevention, 681-685 Shengguang Road, Jimei District, Xiamen, Fujian province, China

    Yanfang Jiang, Yangjingling Hua, Manqi Zhou & Huarong Hong

  3. Faculty of Arts and Social Sciences, the University of Sydney, Sydney, NSW, Australia

    Yuqing Li

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Contributions

Conception and design of the study: LL, HH, ZP and HY. Organized the database and performed the statistical analysis: ZP, YL, HY, YJ, TC, MG, YH, GL, and MZ. Original draft: ZP and YL. Critical review and editing of the manuscript: LL and HH. All authors contributed to the manuscript revision, and read, and approved the submitted version.

Corresponding authors

Correspondence to Huarong Hong or Lei Li.

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Ethics approval and consent to participate

The students participating in the screening and their parents or guardians were informed of the purpose and procedure of the study, and their informed consent was obtained. The study was approved by the Ethics Committee of the Xiamen Center for Disease Control and Prevention (XJKLLSC2024017).

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Not applicable.

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The authors declare no competing interests.

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Peng, Z., Li, Y., Yang, H. et al. Positive rate and influencing factors of adolescent idiopathic scoliosis among school children aged 9 to 18 years in Xiamen, China. BMC Pediatr 25, 216 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12887-025-05566-z

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Keywords

BMC Pediatrics

ISSN: 1471-2431

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