The role of traditional social determinants of health in referral patterns, timing of surgery, and Chiari Health Index for Pediatrics–determined quality of life in children with symptomatic Chiari type I malformation
Vanderbilt University School of Medicine, Nashville, Tennessee;
Department of Neurological Surgery, University of Washington, Seattle, Washington; and
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Vanderbilt University School of Medicine, Nashville, Tennessee;
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Vanderbilt University School of Medicine, Nashville, Tennessee;
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Vanderbilt University School of Medicine, Nashville, Tennessee;
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Vanderbilt University School of Medicine, Nashville, Tennessee;
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Vanderbilt University School of Medicine, Nashville, Tennessee;
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Vanderbilt University School of Medicine, Nashville, Tennessee;
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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OBJECTIVE
Understanding the impact of the social determinants of health on the utilization of healthcare resources is an important step in eliminating inequalities. The goal of this study was to determine the role of social determinants of health in referral patterns, timing of consultation/intervention, and quality of life in children with Chiari malformation type I (CM-I).
METHODS
A retrospective study was conducted of children aged 0 to 18 years who underwent surgical treatment for CM-I at a single pediatric facility from 2015 to 2019. The variables included demographic and socioeconomic characteristics, referral patterns, timing, and quality of life data based on the Chiari Health Index for Pediatrics (CHIP).
RESULTS
The cohort consisted of 103 surgically treated CM-I patients. No differences were seen in race, sex, insurance, or household income when evaluating referral source (community, specialist, or emergency department) or when comparing patients with incidental versus symptomatic findings. In the evaluation of timing from initial evaluation to surgery, no statistical differences were seen between racial, sex, insurance status, or income groups. Children from households of lower median family income were significantly more likely to report pain at the time of consultation (pain group median [interquartile range] $46,660 [$41,004–$50,367] vs nonpain group $53,604 [$41,427–$59,828], p = 0.004). Those in the lower-income group also reported lower CHIP scores corresponding to increased symptomatology in the nonpain physical symptoms (p = 0.004) and psychosocial domains (p = 0.018).
CONCLUSIONS
There was no evidence of a difference in referral patterns or a delay in time from clinic presentation to surgery based on the traditional social determinants of health categories. Children from households in the lower-income group were associated with increased severity of pain and nonpain symptoms.
ABBREVIATIONS
ADI = Area Deprivation Index; CHIP = Chiari Health Index for Pediatrics; CM-I = Chiari malformation type I; IQR = interquartile range.
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