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The Impact of Socioeconomic Status on Timely Presentation and Treatment in Pediatric Hand Fractures
Henok G Haile1, Rebecca D Aguiar2, Patrice Melvin3,4
1Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Insights
Children with lower socioeconomic status, indicated by Child Opportunity Index (COI) scores, experience delayed presentation for hand fractures. This delay is independent of insurance type, race, or language, highlighting the need for targeted interventions.
Area of Science:
- Orthopedic surgery
- Pediatric health
- Health equity
Background:
- Pediatric hand fractures are common injuries.
- Disparities in management and outcomes for pediatric hand fractures are not well understood.
- Socioeconomic status (SES) and health insurance may influence care access and outcomes.
Purpose of the Study:
- To investigate the impact of SES and health insurance on pediatric hand fracture presentation time, treatment, and outcomes.
- To identify disparities in care for pediatric hand fractures.
Main Methods:
- Retrospective cohort study of 300 pediatric patients with hand fractures (2021-2022).
- Analysis of presentation time, operative vs. non-operative treatment, and outcomes.
- Multivariable regression to assess the influence of sociodemographics, Child Opportunity Index (COI), and fracture characteristics.
Main Results:
- 21% of patients experienced delayed presentation (>8 days).
- Lower COI scores were significantly associated with delayed presentation.
- No significant differences in delayed presentation or intervention type based on sex, race, language, or insurance type were found.
Conclusions:
- Lower socioeconomic status, as measured by COI, is a key factor in delayed presentation for pediatric hand fractures.
- Addressing socioeconomic barriers is crucial for improving timely access to care.
- Targeted interventions are needed to ensure equitable care for all pediatric patients with hand fractures.
Background:
Pediatric hand fractures are common, yet disparities in their management and outcomes remain underexplored. The purpose of this study is to investigate the influence of socioeconomic status (SES) and health insurance status on time-to-presentation, treatment, and outcomes for pediatric hand fractures.
Methods:
We conducted a retrospective cohort study of pediatric patients who presented with hand fractures between January 2021 and December 2022, identified through electronic health records. Patient demographics, date of presentation, treatment (operative vs non-operative), and outcomes were assessed. Multivariable regression analyses were used to evaluate delayed presentation (>8 days from the initial injury, defined as 75th percentile of days to presentation) and need for operative intervention based on sociodemographics, Child Opportunity Index (COI) level (a proxy for SES), and fracture characteristics.
Results:
We included 300 patients (median age: 14 years [interquartile range: 13-16]; 76.7% male). Of these, 63 patients (21.0%) experienced delayed presentation, and 38 patients (12.7%) underwent operative intervention. forty-fiveIn total 145, patients (48.3%) had private insurance and 155 (51.7%) had public insurance. The multivariable analysis showed no statistically significant differences in delayed presentation based on sex, race, primary language, or type of insurance. However, patients living in neighborhoods with very low to moderate COI were found to have a significant delay in time to presentation compared to those with high to very high COI.
Conclusions:
In this retrospective cohort of pediatric patients with hand fractures, those with lower COI were more likely to experience delayed presentation. No significant differences in time to presentation and intervention type (operative vs non-operative) were observed based on sex, insurance type, primary language, or race/ethnicity. These findings underscore the importance of socioeconomic measures such as COI as separate from race and ethnicity data and highlight the need for focused interventions to ensure equitable care for all pediatric patients.
Key Concepts:
(1)Pediatric patients from low or very low Child Opportunity Index scores are more likely to have a delayed presentation after finger and hand fractures.(2)The observed difference is independent of race, ethnicity, language, and insurance.(3)Care pathways are needed to improve access for these underserved patients with acute injuries.
Level Of Evidence:
IV, Case series.
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