title: The association between race and frequent shunt failure: a single-center study.
abstract: OBJECTIVE
  Children experiencing frequent shunt failure consume medical resources and represent a disproportionate level of morbidity in hydrocephalus care. While biological causes of frequent shunt failure may exist, this study analyzed demographic and socioeconomic patient characteristics associated with frequent shunt failure.
  
  
  METHODS
  A survey of 294 caregivers of children with shunt-treated hydrocephalus provided demographic and socioeconomic characteristics. Children experiencing at least 10 shunt failures were considered frequent shunt-failure patients. Multivariate regression models were used to control for variables.
  
  
  RESULTS
  Frequent shunt failure was experienced by 9.5% of the patients (28 of 294). By univariate analysis, white race (p = 0.006), etiology of hydrocephalus (p = 0.022), years-with-shunt (p < 0.0001), and surgeon (p = 0.02) were associated with frequent shunt failure. Upon multivariate analysis, white race remained the key independent factor associated with frequent shunt failure (OR 5.8, 95% CI 1.2-27.8, p = 0.027). Race acted independently from socioeconomic factors, including income, level of education, and geographic location, and clinical factors, such as etiology of hydrocephalus, surgeon, and years-with-shunt. Additionally, after multivariate analysis surgeon and years-with-shunt remained associated with frequent shunt failure (p = 0.043 and p = 0.0098, respectively), although etiology of hydrocephalus was no longer associated (p = 0.1).
  
  
  CONCLUSIONS
  White race was the primary independent factor associated with frequent shunt failure. Because races use health care differently and the diagnosis of shunt failure is often subjective, a disparity in diagnosis and treatment has arisen. These findings call for objective criteria for the preoperative and intraoperative diagnosis of shunt failure.
authors: Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15224, USA. naftel@uab.edu
authors: Robert P
authors: RP
authors: Naftel
authors: Nicole A
authors: NA
authors: Safiano
authors: Michael
authors: M
authors: Falola
authors: Jeffrey P
authors: JP
authors: Blount
authors: W Jerry
authors: WJ
authors: Oakes
authors: John C
authors: JC
authors: Wellons
mesh_terms: D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006849:Hydrocephalus / Q000208:ethnology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010817:Physician-Patient Relations; D012086:Reoperation / Q000706:statistics & numerical data; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*