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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.
Insights
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.
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.
Background And Objectives:
Pediatricians conduct routine head shape evaluations with standard preventive care, and inequities in timely detection and referral of craniosynostosis (CS) patients to craniofacial clinicians may exist. Delays in CS treatment could prolong increased intracranial pressure and increase the risk of visual impairment and developmental delay. We assessed variation in timing of CS procedures by Child Opportunity Index (COI) for location of patients' home residence.
Methods:
Retrospective analysis of 4828 infants with CS undergoing procedures from January 1, 2018, to December 31, 2022 in 43 US children's hospitals in the Pediatric Health Information System (PHIS) database. Using analysis of variance, median (IQR) age in days at operation was compared with COI of patients' home residence zip code and other patient sociodemographic characteristics.
Results:
Age at CS procedure varied significantly (P < .001) by infants' COI, ranging from median 5 months (IQR 3-9 months) for very high COI to 8 months (IQR 4-11 months) for very low COI. Across the 43 hospitals, 8 (18.6%) demonstrated a difference of 5 months or greater in age at open operation between infants with highest vs lowest COI; 7 (16.3%) hospitals had a difference under 1 month. Among infants with very low COI, even older ages at open interventions were observed for non-Hispanic Black vs white race/ethnicity (median 10 months [IQR 7-13 months] vs median 9 months [IQR 4-12 months], P < .001).
Conclusion:
Infants with low COI underwent operations for CS months later than infants with high COI. Investigation of CS care at children's hospitals and their surrounding primary care health systems is needed to address this inequity.
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