Journal article
Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia
Journal of neurosurgery. Pediatrics, v 29(3), pp 288-297
01 Mar 2022
PMID: 34861643
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM).
METHODS The authors used retro-and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes.
RESULTS A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively).
CONCLUSIONS Socioeconomic and demographic factors appear to influence the presentation and management of pa- tients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.
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Details
- Title
- Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia
- Creators
- Syed Hassan A. Akbari - Penn State Milton S. Hershey Medical CenterAsad A. Rizvi - College Station Medical CenterTravis S. CreveCoeur - College Station Medical CenterRowland H. Han - College Station Medical CenterJacob K. Greenberg - College Station Medical CenterJames Torner - University of IowaDouglas L. Brockmeyer - University of UtahJohn C. Wellons - Neurological SurgeryJeffrey R. Leonard - The Ohio State UniversityFrancesco T. Mangano - Cincinnati Children's Hospital Medical CenterJames M. Johnston - University of Alabama at BirminghamManish N. Shah - The University of Texas Health Science Center at HoustonBermans J. Iskandar - University of Wisconsin–MadisonRaheel Ahmed - University of Wisconsin–MadisonGerald F. Tuite - Johns Hopkins All Children's HospitalBruce A. Kaufman - Medical College of WisconsinDavid J. Daniels - Mayo ClinicEric M. Jackson - Johns Hopkins UniversityGerald A. Grant - Stanford Health CareAlexander K. Powers - Atrium Health Wake Forest BaptistDaniel E. Couture - Atrium Health Wake Forest BaptistP. David Adelson - Barrow Neurological InstituteTord D. Alden - Lurie Children's HospitalPhilipp R. Aldana - Florida CollegeRichard C. E. Anderson - Columbia UniversityNathan R. Selden - Oregon Health & Science UniversityKarin Bierbrauer - Cincinnati Children's Hospital Medical CenterWilliam Boydston - Children's Healthcare of AtlantaJoshua J. Chern - Children's Healthcare of AtlantaWilliam E. Whitehead - Baylor College of MedicineRobert C. Dauser - Baylor College of MedicineRichard G. Ellenbogen - University of WashingtonJeffrey G. Ojemann - University of WashingtonHerbert E. Fuchs - Duke UniversityDaniel J. Guillaume - University of Minnesota Medical CenterTodd C. Hankinson - Children's Hospital ColoradoBrent R. O'Neill - Childrens Hosp Colorado, Dept Neurosurg, Aurora, CO USAMark Iantosca - Penn State Milton S. Hershey Medical CenterW. Jerry Oakes - University of Alabama at BirminghamRobert F. Keating - Children's NationalPaul Klimo - University of Tennessee Health Science CenterMichael S. Muhlbauer - University of Tennessee Health Science CenterJ. Gordon McComb - Children's Hospital of Los AngelesArnold H. Menezes - University of Iowa Hospitals and ClinicsNickalus R. Khan - University of Miami HospitalToba N. Niazi - University of Miami HospitalJohn Ragheb - University of Miami HospitalChevis N. Shannon - Vanderbilt University Medical CenterJodi L. Smith - Neurological SurgeryLaurie L. Ackerman - Neurological SurgeryAndrew H. Jea - Neurological SurgeryCormac O. Maher - University of Michigan–Ann ArborPrithvi Narayan - St. Christopher's Hospital for ChildrenGregory W. Albert - College Station Medical CenterScellig S. D. Stone - College Station Medical CenterLissa C. Baird - Harvard UniversityNaina L. Gross - University of OklahomaSusan R. Durham - University of Vermont Medical CenterStephanie Greene - University of Pittsburgh Medical CenterRobert C. McKinstry - Washington University in St. LouisJoshua S. Shimony - Washington University in St. LouisJennifer M. Strahle - College Station Medical CenterMatthew D. Smyth - College Station Medical CenterRalph G. Dacey - College Station Medical CenterTae Sung Park - College Station Medical CenterDavid D. Limbrick - College Station Medical Center
- Publication Details
- Journal of neurosurgery. Pediatrics, v 29(3), pp 288-297
- Publisher
- Amer Assoc Neurological Surgeons
- Number of pages
- 10
- Grant note
- American Syringomyelia Alliance Project, Inc. UL1 TR002345 / National Center for Advancing Translational Sciences of the NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; Neurosurgery
- Web of Science ID
- WOS:000766787800007
- Scopus ID
- 2-s2.0-85127279892
- Other Identifier
- 991021955155304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Pediatrics
- Surgery