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Socioeconomic Disparities in Surgical Care for Congenital Hand Differences
Christopher L Kalmar1, Brian C Drolet1
1Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Socioeconomic factors impact access to congenital hand surgery, with higher status patients more likely to receive care at high-volume hospitals. This care is linked to earlier surgery and lower costs.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Access to specialized pediatric care, such as congenital hand surgery, can be influenced by socioeconomic and geographic factors.
- Disparities in access may affect patient outcomes and healthcare costs.
Purpose of the Study:
- To evaluate how socioeconomic factors influence access to congenital hand surgery.
- To analyze the impact of these factors on hospital admission charges and geographic trends in care delivery.
Main Methods:
- A retrospective cohort study analyzed data from 5531 pediatric patients undergoing congenital hand surgery in the US (2010-2020).
- The Pediatric Health Information System was utilized for data extraction.
- Multivariate regression analysis was employed to assess the influence of socioeconomic factors.
Main Results:
- Patients with higher income, non-white race, commercial insurance, urban residence, and non-underserved area status were more likely to be treated at high-volume hospitals.
- Nearly half of patients traveled to a distant hospital, often a higher-volume facility.
- White patients were more likely to choose distant, higher-volume hospitals.
Conclusions:
- Socioeconomic and geographic factors create disparities in access to congenital hand surgery.
- Higher socioeconomic status is associated with treatment at high-volume centers.
- High-volume hospital care correlates with earlier surgery and reduced hospital admission charges.
Background:
The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country.
Methods:
Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors.
Results:
During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals (P < .001). Patients with above-median income (P < .001), non-white race (P < .001), commercial insurance (P < .001), living in an urban community (P < .001), and not living in an underserved area (P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital (P < .001).
Conclusions:
Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges.
