Socioeconomic Factors Impact the Timing of Surgical Repair for Craniosynostosis - A Regional and National Assessment

Abstract

Introduction: Timing of repair for patients with craniosynostosis are usually categorized into early “˜minimally invasive”™ surgeries such as strip craniotomy (SC), whereas those presenting later undergoing traditional cranial vault remolding (CVR). The impact that sociodemographic and socioeconomic disparities have on time to presentation for craniosynostosis and treatment is unknown. Herein, we examined sociodemographic and socioeconomic factors among a heterogenous patient population at a single institution who underwent craniosynostosis repair and compared this cohort to a national database. Methods: A retrospective review of patients at UTHealth who underwent craniosynostosis repair from 2016 to 2020 was performed. The patients were divided into cohorts based on type of operation: SC or cranial vault remolding. The Kid inpatient Database (KiD) database was used to assess sociodemographic factors in relation to craniosynostosis. Univariate and multivariate logistic regression were used to determine significant predictors and differences. Results: Single Institution (Regional): Compared with nonHispanic white (NHW) patients, Hispanic (OR 0.11), and NonHispanic Black (NHB) (OR 0.14) had lower odds of undergoing SC. Compared to those on private insurance, patients on Medicaid (OR 0.36) had lower odds of undergoing SC. Using zip code median income levels, patients with a higher median income level had slightly higher odds of undergoing SC compared to patients with a lower median income (OR 1.000025). KIDS (National): Compared with non-Hispanic white patients, NHB (OR 0.32) and Asian (OR 0.47) patients had lower odds of undergoing repair before the age of 1. Compared to patients with private insurance, those with Medicaid (OR 0.67) and self-pay (OR 0.58) had lower odds of undergoing repair before the age of 1. Patients in the lowest income quartile (OR 0.68) and second lowest income quartile (OR 0.71) had lower odds of undergoing repair before the age of 1 compared to the highest quartile. Conclusions: Our findings indicate that sociodemographic and socioeconomic factors may play a role in diagnosis of craniosynostosis and access to care. Patients of NHB and Hispanic race, lower income quartiles by zip code, and those that use public insurance are less likely to undergo early repair, both nationally and at our institution. Further research is needed to delineate the casualty of this disparity in presentation and timing of surgery.

Treatment Delays in Nonsyndromic Craniosynostosis

“…[30][31][32][33] Medicaid coverage within our study was associated with greater odds of surgical delay. However, contrary to recent literature, 15,16,[22][23][24] we did not find delays in the care timeline associated with insurance, although this marker was not universally available in patient records.…”

“…Racial and ethnic minorities, especially Black patients, are known to suffer disparate access to timely and effective care. 22 Aligning with recent literature, 7,15,16,[23][24][25] in our study Black race was a strong correlate of both inexpedient clinic presentation and subsequent treatment delay. Presenting for their index clinic visit an average of 8 months older than White counterparts, Black patients had more than 3.5 times greater odds of surgical delay.…”

“…Current literature has not investigated NSC care disparities in the preoperative clinical period, hypothesizing that the impact of sociodemographic barriers is limited to attaining provider access 23,24 . Oppositely, we found that these disparities extended through the in-clinic progression to surgery.…”

“…Current literature has not investigated NSC care disparities in the preoperative clinical period, hypothesizing that the impact of sociodemographic barriers is limited to attaining provider access. 23,24 Oppositely, we found that these disparities extended through the in-clinic progression to surgery. Nonattendance at pediatric neurosurgery and plastic surgery clinics is rare, 34 with care-seeking behavior positively correlated with the racial and SES groups associated with preclinical delays.…”

Geospatial and Socioeconomic Disparities Influencing the Management of Craniosynostosis

“…Insurance payor, race, and median zip code income quartiles have been well-described socioeconomic indicators related to craniosynostosis management. [14][15][16][17][18][19][20] However, systematic review of the literature highlighted a knowledge gap surrounding geospatial disparities and other socioeconomic indicators such as parental education attainment. In addition, zip code-based metrics lack granularity and vary tremendously in size, shape, and population.…”