Introduction: Racial and socioeconomic disparities within the US health care system lead to inequality in accessibility of needed health services and are a growing concern. The effect of disparities has only been sparsely studied for accessibility to pediatric neurosurgery care. We analyzed its potential impact on care for spasticity in children.
Methods: We abstracted patient data from the Goodman Campbell Brain and Spine database from 2010 to 2016. We evaluated the effects of race, household income, hospital accessibility and payer status on outcomes. Fisher’s exact tests and the two-tailed t-test were used in the analysis.
Results: Nineteen non-white patients were evaluated compared with 97 Caucasian patients. Analogously, there were 19 patients from households with <$25,000, and 97 patients from households =$25,000. However, the type of referring physician did not differ between racial groups (p = 0.3087), payer status (p = 0.2999), or household income (p =1.0000). Distance to hospital did not differ between racial groups (p = 0.1366), payer status (p = 0.0635), or household income (0.0794). The mean time between initial evaluation and surgery was 1163.03 days (range, 25 to 4437 days); the mean distance traveled for care was 76.59 minutes (range, 11 to 166 minutes). Both these surrogates to measure accessibility were unacceptably long.
Conclusions: Our findings suggest the lack of racial and socioeconomic disparities in the care for spasticity once the child has been referred to pediatric neurosurgery. However, accessibility to neurosurgical care for spasticity remains a significant barrier across race and socioeconomic status.
Patient Care: The ideal care team for the child with spasticity is a multidisciplinary group including primary care physicians/pediatricians, physiatrists, physical and occupational therapists, neurologist, orthopedic surgeons, as well as neurosurgeons. The goal is to coordinate care, to maximize therapy and support, as well as to optimize decision making for comprehensive management.
Learning Objectives: In this study, we investigated racial and socioeconomic disparities in access for care of children with spasticity given its enormous clinical and economic implications. These same disparities have been studied in a limited fashion in other aspects of pediatric neurosurgery, such as craniosynostosis, neurooncology, and CSF shunting. However, to the best of our knowledge, they have not been analyzed for surgical treatment of spasticity. We identified a correlation with race and socioeconomic status in referral pattern. There were disproportionately lower numbers of non-White patients and patients from households below the poverty line, who were referred to neurosurgery for evaluation. At the same time, we demonstrated that all patients, regardless of race or socioeconomic status, had greater hardship in reaching tertiary care (longer travel times and lead times to surgery).