The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries

Patel, Neeraj M.; Edison, Bianca; Carter, Cordelia W.; Pandya, Nirav K.

doi:10.1016/j.csm.2022.05.012

Cited by 7 publications

(3 citation statements)

References 59 publications

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“…These potential explanations include racial differences in socioeconomic status, access to resources, health literacy, or cultural practices as well as implicit bias among providers. 36-38 Historical or ongoing systematic and discriminatory practices, such as residential segregation, that disproportionately impact racial minority groups may also play a role in the disparities observed in our review. 39 More than likely, the reasons for the racial disparities affecting patients with CL/P are multifactorial, involving a complex combination of the aforementioned factors.…”

Section: Discussionmentioning

confidence: 96%

Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip

Obinero,

Boyd,

Barrera

et al. 2024

FACE

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Introduction: Comprehensive management of cleft lip with or without cleft palate (CL/P) often begins prenatally, continues into adulthood, and involves multidisciplinary collaboration. This study aims to review the current literature and summarize sociodemographic disparities that impact access to care, management, and postoperative outcomes in patients with CL/P. Methods: A systematic review was conducted using Pubmed, Embase, and Medline databases. Studies discussing sociodemographic disparities regarding access to care, management, and treatment outcomes for patients with CL/P were included. Studies performed outside the US and published before the year 2000 were excluded. Results: Of 3782 studies initially identified, 26 met the inclusion criteria. Disparities discussed included access to care (n = 11), missed appointments (n = 2), use of nasoalveolar molding [NAM] (n = 3), surgical timing (n = 8), and surgical outcomes (n = 8). Minority race or ethnicity, particularly black, Hispanic, Asian, and Native-American, as well as public insurance were associated with impaired access to care. Other factors causing impaired access to care were non-English primary language and high cost. Predictors for missed appointments were black race and Medicaid insurance. Decreased use of or success with NAM was associated with Asian race, public insurance, and long travel distance to a cleft care center. Factors associated with delayed CL surgery were Asian or black race, Hispanic ethnicity, public insurance, and non-English primary language. Surgical outcomes were assessed using various esthetic, speech, and quality of life measures; factors linked to worse outcomes included black or latin race and public insurance. Conclusion: Patients with CL/P from minority racial or ethnic groups, particularly black, Asian, and Hispanic, as well as those with public insurance are disproportionately impacted by health disparities. Disparities related to age, geographic location, and primary language have also been reported, among others. Statewide or institutional social programs may help address these disparities.

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Section: Discussionmentioning

confidence: 96%

Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip

Obinero,

Boyd,

Barrera

et al. 2024

FACE

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“…[1][2][3][4][5][6][7] There is increasing interest regarding the effect of health care disparities on the accessibility and delivery of pediatric orthopaedic care in the United States. [1][2][3][8][9][10][11][12] It is known that children with publicly funded insurance wait longer to access general pediatric orthopaedic care, including scoliosis care. [13][14][15] A recent significant emphasis on understanding the root causes of such disparities as they pertain to adolescent idiopathic scoliosis (AIS) care exists.…”

mentioning

confidence: 99%

“…Children with publicly funded insurance, an indirect marker of socioeconomic status (SES), household income, and ethnicity are significantly more likely to experience unmet health care needs, obesity, and potentially poorer surgical outcomes 1–7 . There is increasing interest regarding the effect of health care disparities on the accessibility and delivery of pediatric orthopaedic care in the United States 1–3,8–12 . It is known that children with publicly funded insurance wait longer to access general pediatric orthopaedic care, including scoliosis care 13–15 .…”

mentioning

confidence: 99%

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

Thornley,

Garner,

Rogers

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery. Methods: A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant. Results: The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients (P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions (P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions (P < 0.001, P = 0.050) and decreased rates of obtaining second opinions (P = 0.004, P = 0.001). Conclusion: Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care. Level of Evidence: Level III; retrospective case-control study.

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Racial and Ethnic Disparities in Pediatric Musculoskeletal Care

Sborov,

Haruno,

Raszka

et al. 2023

Curr Rev Musculoskelet Med

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The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries

Cited by 7 publications

References 59 publications

Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip

Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

Racial and Ethnic Disparities in Pediatric Musculoskeletal Care

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