Division of Plastic Surgery, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
J Craniofac Surg. 2022;33(5):1497-1501. doi: 10.1097/SCS.0000000000008405. Epub 2021 Dec 6.
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.
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.
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).
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.
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.
颅缝早闭患者的修复时机通常分为早期的“微创”手术，如颅骨切开术（SC），而那些较晚就诊的患者则采用传统的颅盖重塑（CVR）。社会人口统计学和社会经济差异对颅缝早闭的就诊时间和治疗的影响尚不清楚。在此，我们检查了在单一机构接受颅缝早闭修复的异质患者人群中的社会人口统计学和社会经济因素，并将该队列与国家数据库进行了比较。
对 2016 年至 2020 年在 UTHealth 接受颅缝早闭修复的患者进行了回顾性研究。根据手术类型将患者分为 SC 或颅盖重塑组。使用 Kid 住院患者数据库（KiD）评估与颅缝早闭相关的社会人口统计学因素。采用单变量和多变量逻辑回归确定显著预测因素和差异。
单一机构（区域性）：与非西班牙裔白人（NHW）患者相比，西班牙裔（OR 0.11）和非西班牙裔黑人（NHB）（OR 0.14）接受 SC 的可能性较低。与私人保险相比，医疗补助（Medicaid）患者（OR 0.36）接受 SC 的可能性较低。根据邮政编码中位数收入水平，收入较高的患者接受 SC 的可能性略高于收入较低的患者（OR 1.000025）。
KIDS 国家：与非西班牙裔白人患者相比，NHB（OR 0.32）和亚洲裔（OR 0.47）患者在 1 岁之前接受修复的可能性较低。与私人保险相比，医疗补助（Medicaid）（OR 0.67）和自付（OR 0.58）患者在 1 岁之前接受修复的可能性较低。收入最低的四分位数（OR 0.68）和第二低的四分位数（OR 0.71）患者在 1 岁之前接受修复的可能性低于最高四分位数。
我们的研究结果表明，社会人口统计学和社会经济因素可能在颅缝早闭的诊断和治疗机会中发挥作用。NHB 和西班牙裔患者、邮政编码收入较低的四分位数患者以及使用公共保险的患者，无论是在全国范围内还是在我们的机构内，都不太可能接受早期修复。需要进一步研究以阐明这种表现和手术时机差异的因果关系。
