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Disparities in insurance status negatively affect patients with infantile hypertrophic pyloric stenosis
Daniel A Reich1, Genesys Giraldo2, William Canty2
1College of Medicine, University of Florida, 1142 SW 9th Rd. Unit 401, Gainesville, FL, 32601, USA. Daniel.reich@ufl.edu.
Insights
Social determinants of health impact infantile hypertrophic pyloric stenosis (IHPS) care. Medicaid Managed Care (MMC) may improve access to care for infants with IHPS, leading to earlier diagnosis and treatment.
Area of Science:
- Pediatric Surgery
- Public Health
- Health Services Research
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition in infants.
- Prolonged illness duration before presentation is associated with worse IHPS outcomes.
- Social determinants of health (SDOH) may influence healthcare access and outcomes for IHPS patients.
Purpose of the Study:
- To evaluate how SDOH influence medical care and outcomes for infants with IHPS.
- To assess the impact of Medicaid Managed Care (MMC) on IHPS patient care and outcomes.
Main Methods:
- Retrospective review of 279 IHPS cases over 10 years.
- Used census data (Geo-Identification codes) as a proxy for socioeconomic status.
- Correlated food access and social vulnerability variables with IHPS presentation and outcomes.
- Subdivided cohort to analyze the impact of phased MMC implementation.
Main Results:
- Infants presenting after phased MMC implementation were older at presentation (41.5 vs. 36.5 days) and had a longer symptomatic course (12.8 vs. 8.9 days).
- No significant differences observed in race, gender, or length of stay between groups.
- Infants with public insurance post-MMC were more likely to have timely outpatient pediatric follow-up (within 1 month).
Conclusions:
- Phased MMC implementation was associated with older presentation age and longer symptomatic duration for IHPS.
- Despite delays, MMC may have improved outpatient follow-up rates for publicly insured infants with IHPS.
- SDOH, particularly through insurance models like MMC, play a crucial role in IHPS care delivery and outcomes.
Purpose:
Infantile hypertrophic pyloric stenosis (IHPS) is suspected to have worse outcomes when length of illness prior to presentation is prolonged. Our objective was to evaluate how social determinants of health influence medical care and outcomes for babies with IHPS.
Methods:
A retrospective review was performed over 10 years. Census data were used as proxy for socioeconomic status via Geo-Identification codes and correlated with food access and social vulnerability variables. The cohort was subdivided to understand the impact of Medicaid Managed Care (MMC).
Results:
The cohort (279 cases) was divided into two groups; early group from 2011 to 2015 and late from 2016 to 2021. Cases in the late group were older at the time of presentation (41.5 vs. 36.5 days; p = 0.022) and presented later in the disease course (12.8 vs. 8.9 days; p = 0.021). There was no difference in race (p = 0.282), gender (p = 0.874), or length of stay.
Conclusions:
Patients who presented with IHPS after implementation of phased MMC were older, had a longer symptomatic course, and shorter pylorus measurements. Patients with public insurance after the implementation of MMC were more likely to follow-up with an outpatient pediatrician within a month of hospitalization. These results suggest that MMC may have improved access to care for infants with IHPS.
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