Race Is Associated With Delayed Diagnosis of Sagittal Craniosynostosis: A Single-Institutional Retrospective Study

ObjectiveIdentify factors associated with delayed diagnosis of sagittal craniosynostosis.DesignRetrospective cohort study.SettingSingle institution tertiary care center over 10 years.PatientsNinety-one patients diagnosed with sagittal craniosynostosis.InterventionsVariables collected included sex, race, ethnicity, age at diagnosis, insurance type, distance traveled, community designation and Area Deprivation Index (ADI), cephalic index (CI), and prematurity (birth at gestational age < 37 weeks). Statistical analysis was performed using Fisher exact test, Wilcoxon-sum test, and multivariable logistic regression.Main Outcome Measure(s):Age at diagnosis and factors associated with delayed diagnosis (>6 months of age).ResultsOn univariable analysis, diagnosis >6 months of age was associated with a greater proportion of non-Hispanic black patients (44% vs 8%, P < .001) and a smaller proportion of non-Hispanic white patients (39% vs 79%, P < .001). A greater proportion of patients had CI ≥ 75 (55% vs 6%, P < .001), and a greater proportion of patients had public insurance (68% vs 38%, P = .008). On multivariable logistic regression non-Hispanic black patients were nearly 7 times more likely compared to non-Hispanic white patients to experience delayed diagnosis when controlling for national (OR 6.96, P = .018) or state ADI (OR 6.51, P = .039).ConclusionAfter adjusting for multiple clinical and sociodemographic factors including insurance type and CI, black patients were nearly 7 times more likely than white patients to experience delayed diagnosis of sagittal craniosynostosis. Future studies are needed to identify modifiable factors contributing to this diagnosis gap and identify opportunities to close it.