Evaluating the Association Between Scoliosis and Thoracic Aortic Aneurysms in Middle-Aged Adults: A Nationwide Retrospective Cohort Study Using Data from the Brazilian Unified Health System (SUS) Database

Evaluating the Association Between Scoliosis and Thoracic Aortic Aneurysms in Middle-Aged Adults: A Nationwide Retrospective Cohort Study Using Data from the Brazilian Unified Health System (SUS) Database Abstract Background: Scoliosis and thoracic aortic aneurysms (TAA) are conditions that may share developmental, connective-tissue, or biomechanical pathways, yet their potential association in middle-aged adults remains incompletely characterized at the population level. Large-scale data from national health systems offer an opportunity to evaluate this relationship with adequate statistical power while accounting for relevant comorbidities and demographic factors. Objective: To investigate the association between scoliosis and the subsequent diagnosis of thoracic aortic aneurysm among middle-aged adults in Brazil, using nationwide administrative data from the Unified Health System (SUS). Methods: We conducted a retrospective cohort study of adults aged 40–64 years with records in the SUS database. Individuals with a documented diagnosis of scoliosis were identified and matched or adjusted for comparison against those without scoliosis. Incident TAA diagnoses were ascertained using standardized diagnostic codes. Multivariable Cox proportional hazards or logistic regression models, adjusted for age, sex, hypertension, connective-tissue disorders, smoking-related proxies, and other relevant covariates available in administrative data, were used to estimate the association between scoliosis and TAA. Sensitivity analyses addressed coding validity, competing risks, and subgroup effects by scoliosis severity or laterality where data permitted. Results: (To be reported upon analysis of the national cohort.) Primary results will include adjusted hazard ratios or odds ratios for TAA in individuals with versus without scoliosis, absolute incidence rates, and stratified estimates by demographic and clinical subgroups. Conclusions: This nationwide retrospective cohort study will provide population-level evidence on whether scoliosis is associated with an increased risk of thoracic aortic aneurysm in middle-aged adults. Findings may inform clinical awareness, risk stratification, and future mechanistic or screening research linking spinal deformity and aortopathy within the Brazilian health-system context.