Journal article
Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia
Journal of neurosurgery. Pediatrics, Vol.29(3), pp.288-297
12/2021
DOI: 10.3171/2021.9.PEDS2185
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 patients 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.
Details
- Title: Subtitle
- Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia
- Creators
- Syed Hassan A Akbari - Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaAsad A Rizvi - Departments of Neurological Surgery andArnold H Menezes - Department of Neurosurgery, University of Iowa Hospitals, Iowa City, IowaTravis S CreveCoeur - Departments of Neurological Surgery andRowland H Han - Departments of Neurological Surgery andJacob K Greenberg - Departments of Neurological Surgery andJames Torner - Department of Epidemiology, University of Iowa, Iowa City, IowaDouglas L Brockmeyer - Department of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, UtahJohn C Wellons - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TennesseeJeffrey R Leonard - Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OhioFrancesco T Mangano - Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioJames M Johnston - Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, AlabamaManish N Shah - Department of Pediatric Surgery and Neurosurgery, The University of Texas McGovern Medical School, Houston, TexasBermans J Iskandar - Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinRaheel Ahmed - Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinGerald F Tuite - Department of Neurosurgery, Neuroscience Institute, All Children’s Hospital, St. Petersburg, FloridaBruce A Kaufman - Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WisconsinDavid J Daniels - Department of Neurosurgery, Mayo Clinic, Rochester, MinnesotaEric M Jackson - Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MarylandGerald A Grant - Department of Neurosurgery, Stanford Child Health Research Institute, Stanford, CaliforniaAlexander K Powers - Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North CarolinaDaniel E Couture - Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North CarolinaP. David Adelson - Department of Neurosurgery, Barrow Neurological Institute, Phoenix, ArizonaTord D Alden - Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, IllinoisPhilipp R Aldana - Department of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FloridaRichard C. E Anderson - Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New YorkNathan R Selden - Department of Neurological Surgery, Oregon Health & Science University, Portland, OregonKarin Bierbrauer - Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioWilliam Boydston - Department of Neurosurgery, Children’s Healthcare of Atlanta, GeorgiaJoshua J Chern - Department of Neurosurgery, Children’s Healthcare of Atlanta, GeorgiaWilliam E Whitehead - Department of Neurosurgery, Baylor College of Medicine, Houston, TexasRobert C Dauser - Department of Neurosurgery, Baylor College of Medicine, Houston, TexasRichard G Ellenbogen - Department of Neurosurgery, University of Washington Medicine, Seattle, WashingtonJeffrey G Ojemann - Department of Neurosurgery, University of Washington Medicine, Seattle, WashingtonHerbert E Fuchs - Department of Neurosurgery, Duke University School of Medicine, Durham, North CarolinaDaniel J Guillaume - Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MinnesotaTodd C Hankinson - Department of Neurosurgery, Children’s Hospital Colorado, Aurora, ColoradoBrent R O’Neill - Department of Neurosurgery, Children’s Hospital Colorado, Aurora, ColoradoMark Iantosca - Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaW. Jerry Oakes - Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, AlabamaRobert F Keating - Department of Neurosurgery, Children’s National Medical Center, Washington, DCPaul Klimo - Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TennesseeMichael S Muhlbauer - Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TennesseeJ. Gordon McComb - Division of Neurosurgery, Children’s Hospital Los Angeles, CaliforniaNickalus R Khan - Department of Pediatric Neurosurgery, Miami Children’s Hospital and University of Miami Miller School of Medicine, Miami, FloridaToba N Niazi - Department of Pediatric Neurosurgery, Miami Children’s Hospital and University of Miami Miller School of Medicine, Miami, FloridaJohn Ragheb - Department of Pediatric Neurosurgery, Miami Children’s Hospital and University of Miami Miller School of Medicine, Miami, FloridaChevis N Shannon - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TennesseeJodi L Smith - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaLaurie L Ackerman - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaAndrew H Jea - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaCormac O Maher - Department of Neurosurgery, University of Michigan, Ann Arbor, MichiganPrithvi Narayan - Department of Neurological Surgery, St. Christopher’s Hospital, Philadelphia, PennsylvaniaGregory W Albert - Department of Neurosurgery, University of Arkansas College of Medicine, Little Rock, ArkansasScellig S. D Stone - Department of Neurosurgery, Harvard Medical School, Boston, MassachusettsLissa C Baird - Department of Neurosurgery, Harvard Medical School, Boston, MassachusettsNaina L Gross - Department of Neurosurgery, University of Oklahoma, Oklahoma City, OklahomaSusan R Durham - Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; andStephanie Greene - Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaRobert C McKinstry - Radiology, Washington University School of Medicine, St. Louis, MissouriJoshua S Shimony - Radiology, Washington University School of Medicine, St. Louis, MissouriJennifer M Strahle - Departments of Neurological Surgery andMatthew D Smyth - Departments of Neurological Surgery andRalph G Dacey - Departments of Neurological Surgery andTae Sung Park - Departments of Neurological Surgery andDavid D Limbrick - Departments of Neurological Surgery and
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.29(3), pp.288-297
- DOI
- 10.3171/2021.9.PEDS2185
- ISSN
- 1933-0707
- eISSN
- 1933-0715
- Language
- English
- Date published
- 12/2021
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Psychological and Brain Sciences; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984214957002771
Metrics
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