Screening positive rate and radiographically confirmed prevalence of scoliosis in Chinese children and adolescents from 2020 to 2025: a systematic review and meta-analysis

Background School-based scoliosis studies often report screening positivity and radiographic confirmation as equivalent prevalence measures despite differences in diagnostic stage and denominator. In this study, we separately estimated screening-positive rates and radiographically confirmed prevalence among Chinese children and adolescents surveyed during 2020–2025. Methods Six databases were searched for Chinese- or English-language studies published from January 2020 to May 2026. Eligible school- or population-based cross-sectional studies included participants aged 6–18 years or primary and secondary school students. Random-effects meta-analyses were performed using logit-transformed proportions and restricted maximum likelihood estimation. Heterogeneity was assessed using I 2 , τ 2 , and 95% prediction intervals (PIs). The review was registered in PROSPERO (CRD420261443909). Results A total of 103 independent studies were included. Eighty-four studies contributed 95 screening-positive estimates from 6,045,953 participants, yielding a pooled screening-positive rate of 3.43% (95% CI: 2.98%–3.93%; I 2 = 99.84%; 95% PI: 0.86%–12.70%). Twenty-three studies involving 1,162,720 participants yielded a radiographically confirmed prevalence rate of 1.83% (95% CI: 1.17%–2.86%; I 2 = 99.85%; 95% PI: 0.18%–16.41%). Female-to-male prevalence ratios were 1.58 and 1.49, respectively. Geographic region was associated with radiographically confirmed prevalence at the study level ( P = 0.011). Conclusions Both outcomes showed extreme heterogeneity and wide prediction intervals. The pooled estimates should therefore be interpreted as random-effects averages across heterogeneous study populations rather than fixed national prevalence values. Screening-positive rate and radiographically confirmed prevalence should not be treated as equivalent measures, and regional meta-regression findings should be regarded only as exploratory. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier PROSPERO CRD420261443909.