Care for Chiari malformation type I: the role of socioeconomic disadvantage and race
| العنوان: | Care for Chiari malformation type I: the role of socioeconomic disadvantage and race |
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| المؤلفون: | Brandon G. Rocque, James M. Johnston, Irina Gonzalez-Sigler, Syed Hassan A. Akbari, Sarah B. Rutland, Gabriela R. Oates, Jeffrey P. Blount, Curtis J. Rozzelle, Elizabeth N Alford, Justin McCroskey, Anastasia Arynchyna, Tofey J Leon |
| المصدر: | Journal of Neurosurgery: Pediatrics. 29:305-311 |
| بيانات النشر: | Journal of Neurosurgery Publishing Group (JNSPG), 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Pediatrics, medicine.medical_specialty, education.field_of_study, Decompression, business.industry, Medical record, Population, Ethnic group, General Medicine, medicine.disease, medicine, Social determinants of health, education, business, Socioeconomic status, Syringomyelia, Chiari malformation |
| الوصف: | OBJECTIVE There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population. METHODS Medical records of patients treated for CM-I at the authors’ institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures. RESULTS The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery. CONCLUSIONS Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas. |
| تدمد: | 1933-0715 1933-0707 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::afc84a76cd942bec5e7b252a9a8935f2Test https://doi.org/10.3171/2021.9.peds21258Test |
| رقم الانضمام: | edsair.doi.dedup.....afc84a76cd942bec5e7b252a9a8935f2 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19330715 19330707 |
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