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Racial disparities in hydrocephalus mortality and shunt revision: a study from the Hydrocephalus Clinical Research
Brandon G Rocque1, Hailey Jensen2, Ron W Reeder2
11Department of Neurosurgery, Children's of Alabama, The University of Alabama at Birmingham, Alabama.
Insights
Children with hydrocephalus face higher mortality rates and fewer shunt revisions if they are Black, Hispanic, or other non-White minorities. These findings reveal critical disparities in pediatric hydrocephalus treatment and outcomes.
Area of Science:
- Pediatric Neurosurgery
- Health Disparities Research
- Clinical Epidemiology
Background:
- Previous administrative data studies indicated elevated mortality rates for Black/African American children with shunted hydrocephalus.
- A longitudinal study suggested minority children with hydrocephalus secondary to myelomeningocele had fewer lifetime shunt revisions than White children, hinting at treatment disparities.
Purpose of the Study:
- To investigate racial and ethnic disparities in mortality and shunt revision rates among children with hydrocephalus using the Hydrocephalus Clinical Research Network (HCRN) registry.
- To determine if race and ethnicity are independent predictors of mortality and shunt revision frequency in pediatric hydrocephalus patients.
Main Methods:
- The HCRN registry was queried for patients with shunted hydrocephalus, including those with primary shunt placement before 2023 and follow-up data through March 2024.
- Cox proportional hazards and proportional means models were employed to assess the impact of race and ethnicity on mortality and lifetime shunt revisions, controlling for covariates.
- Key variables included age at initial shunt placement, sex, hydrocephalus etiology, gestational age, and complex chronic conditions.
Main Results:
- Analysis of 5656 children revealed that Black (HR 1.32), other non-White (HR 1.39), and Hispanic (HR 1.50) children had significantly higher mortality rates compared to White children.
- Among 4081 children with shunts, Hispanic ethnicity was independently associated with a lower number of total shunt revisions (HR 0.84).
Conclusions:
- This study demonstrates that Hispanic, Black, and other non-White children with hydrocephalus experience higher mortality rates when controlling for other factors.
- Hispanic children also undergo fewer shunt revisions, underscoring significant potential disparities in hydrocephalus management and treatment outcomes.
- These findings necessitate further investigation into the underlying causes of these disparities to ensure equitable care for all children with hydrocephalus.
Objective:
Several studies of administrative data have noted higher mortality rates for Black/African American children with shunted hydrocephalus. A longitudinal study of children with hydrocephalus secondary to myelomeningocele showed lower lifetime rates of shunt revision in minority children compared to White children, indicating a possible disparity in hydrocephalus treatment. The goal of this study is to identify racial and ethnic disparities in mortality or in shunt revision rates by using the Hydrocephalus Clinical Research Network (HCRN) hydrocephalus registry sample.
Methods:
The HCRN registry was queried for patients with shunted hydrocephalus for whom data on all lifetime hydrocephalus procedures were available. Patients with a primary shunt placement prior to 2023 were included, with follow-up extending through March 19, 2024. A Cox proportional hazards model was created to determine the effect of race and ethnicity on mortality while controlling for age at initial shunt placement, sex, hydrocephalus etiology, gestational age at birth, and presence of complex chronic conditions. Similarly, a proportional means model was used to evaluate association with lifetime number of shunt revision surgeries. The authors' hypothesis was that when controlling for other variables, minority children would have higher mortality and fewer shunt revision surgeries than White children.
Results:
A total of 5656 children were included in the analysis of mortality. There were 579 deaths. Race and ethnicity were independently associated with mortality, with Black (HR 1.32, 95% CI 1.05-1.65), other non-White (HR 1.39, 95% CI 1.03-1.86), and Hispanic (HR 1.50, 95% CI 1.22-1.84) children having a higher mortality rate than White children. In the analysis of 4081 children with shunts, Hispanic ethnicity was also independently associated with fewer total shunt revisions (HR 0.84, 95% CI 0.72-0.98).
Conclusions:
In children with hydrocephalus, when controlling for other factors, there is a higher mortality rate among Hispanic, Black, and other non-White children, and fewer shunt revisions among Hispanic children. These findings highlight important potential disparities in hydrocephalus treatment.
