1Division of Plastic and Reconstructive Surgery, Washington University in St. Louis; and.
2Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
J Neurosurg Pediatr. 2023 May 26;32(3):257-266. doi: 10.3171/2023.4.PEDS2343. Print 2023 Sep 1.
The authors utilized the area deprivation index (ADI), a validated composite measure of socioeconomic disadvantage, and the social vulnerability index (SVI) to examine whether differences in neighborhood deprivation impact interventions and outcomes among patients with craniosynostosis.
Patients who underwent craniosynostosis repair between 2012 and 2017 were included. The authors collected data about demographic characteristics, comorbidities, follow-up visits, interventions, complications, desire for revision, and speech, developmental, and behavioral outcomes. National percentiles for ADI and SVI were determined using zip and Federal Information Processing Standard (FIPS) codes. ADI and SVI were analyzed by tertile. Firth logistic regressions and Spearman correlations were used to assess associations between ADI/SVI tertile and outcomes/interventions that differed on univariate analysis. Subgroup analysis was performed to examine these associations in patients with nonsyndromic craniosynostosis. Differences in length of follow-up among the nonsyndromic patients in the different deprivation groups were assessed with multivariate Cox regressions.
In total, 195 patients were included, with 37% of patients in the most disadvantaged ADI tertile and 20% of patients in the most vulnerable SVI tertile. Patients in more disadvantaged ADI tertiles were less likely to have physician-reported desire (OR 0.17, 95% CI 0.04-0.61, p < 0.01) or parent-reported desire (OR 0.16, 95% CI 0.04-0.52, p < 0.01) for revision, independent of sex and insurance status. In the nonsyndromic subgroup, inclusion in a more disadvantaged ADI tertile was associated with increased odds of speech/language concerns (OR 4.42, 95% CI 1.41-22.62, p < 0.01). There were no differences in interventions received or outcomes among SVI tertiles (p ≥ 0.24). Neither ADI nor SVI tertile was associated with risk of loss to follow-up among nonsyndromic patients (p ≥ 0.38).
Patients from the most disadvantaged neighborhoods may be at risk for poor speech outcomes and different standards of assessment for revision. Neighborhood measures of disadvantage represent a valuable tool to improve patient-centered care by allowing for modification of treatment protocols to meet the unique needs of patients and their families.
作者利用区域剥夺指数（ADI）和社会脆弱性指数（SVI）这两种经过验证的社会经济劣势综合衡量指标，来研究邻里剥夺程度的差异是否会影响颅缝早闭患者的干预措施和结局。
纳入 2012 年至 2017 年间接受颅缝早闭修复的患者。作者收集了患者的人口统计学特征、合并症、随访、干预措施、并发症、是否需要修复、言语、发育和行为结局等数据。使用邮政编码和联邦信息处理标准（FIPS）代码确定 ADI 和 SVI 的全国百分位数。ADI 和 SVI 按三分位数进行分析。采用 Firth 逻辑回归和斯皮尔曼相关分析评估 ADI/SVI 三分位数与单变量分析中不同的结局/干预措施之间的关联。进行亚组分析以检查非综合征性颅缝早闭患者中这些关联。采用多变量 Cox 回归评估不同剥夺程度组中非综合征性患者的随访时间差异。
共纳入 195 例患者，其中 37%的患者处于 ADI 最不利的三分位数，20%的患者处于 SVI 最脆弱的三分位数。处于更不利 ADI 三分位数的患者，医生报告的修复意愿（比值比[OR]0.17，95%置信区间[CI]0.04-0.61，p<0.01）或父母报告的修复意愿（OR 0.16，95%CI 0.04-0.52，p<0.01）均较低，与性别和保险状况无关。在非综合征亚组中，纳入更不利的 ADI 三分位数与言语/语言问题的风险增加相关（比值比[OR]4.42，95%CI 1.41-22.62，p<0.01）。SVI 三分位数之间的干预措施或结局无差异（p≥0.24）。非综合征患者中，ADI 或 SVI 三分位数与随访丢失风险无关（p≥0.38）。
来自最贫困社区的患者可能存在言语结局较差和修复评估标准不同的风险。劣势邻里措施代表了一种有价值的工具，可以通过修改治疗方案来满足患者及其家庭的独特需求，从而改善以患者为中心的护理。
