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Updated: Sep 9, 2025

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Inequities in Operative Age for Infants With Craniosynostosis.

Daniel M Balkin1, Valerie L Ward2,3, John G Meara1

  • 1Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Pediatrics
|August 31, 2025
PubMed
Summary

Infants with lower socioeconomic status experienced delays in craniosynostosis (CS) surgery. This study highlights disparities in CS treatment timing based on the Child Opportunity Index (COI), emphasizing the need for equitable care.

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Area of Science:

  • Pediatric Surgery
  • Public Health
  • Health Equity

Background:

  • Craniosynostosis (CS) requires timely surgical intervention to prevent complications like increased intracranial pressure, visual impairment, and developmental delay.
  • Routine head shape evaluations by pediatricians may miss subtle signs of CS, potentially leading to delayed diagnosis and treatment.
  • Existing healthcare inequities may affect the timely detection and referral of infants with CS.

Purpose of the Study:

  • To assess the variation in the timing of craniosynostosis (CS) procedures based on the Child Opportunity Index (COI) of patients' residential locations.
  • To identify potential socioeconomic disparities in the surgical treatment of CS in infants.
  • To investigate the impact of neighborhood opportunity on the timeliness of CS interventions.

Main Methods:

  • Retrospective analysis of 4828 infants diagnosed with CS who underwent surgical procedures between January 1, 2018, and December 31, 2022.
  • Data were sourced from the Pediatric Health Information System (PHIS) database across 43 US children's hospitals.
  • Analysis of variance was used to compare the median age at operation with the COI of patients' zip codes and other sociodemographic factors.

Main Results:

  • A significant variation in the age of CS procedures was observed based on infants' COI (P < .001).
  • Infants in very low COI areas had a median age of 8 months (IQR 4-11 months) for surgery, compared to 5 months (IQR 3-9 months) for very high COI areas.
  • Disparities were also noted by race/ethnicity, with non-Hispanic Black infants in very low COI areas undergoing surgery later than white infants.

Conclusions:

  • Infants residing in lower socioeconomic opportunity areas experience significant delays in undergoing craniosynostosis surgery.
  • These findings underscore critical inequities in CS care, necessitating further investigation into healthcare systems and primary care networks.
  • Addressing these disparities is crucial to ensure timely and equitable treatment for all infants with craniosynostosis.