title: Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures.
abstract: OBJECT Racial and socioeconomic disparities within the US health care system are a growing concern. Despite extensive research and efforts to narrow such disparities, minorities and economically disadvantaged patients continue to exhibit inferior health care outcomes. Disparities in the delivery of pediatric neurosurgical care are understudied. Authors of this study examine the impact of race and socioeconomic status on outcomes following pediatric CSF shunting procedures. METHODS Discharge information from the 2000, 2003, 2006, and 2009 Kids' Inpatient Database for individuals (age < 21 years) with a diagnosis of hydrocephalus who had undergone CSF shunting procedures was abstracted for analysis. Multivariate logistic regression analyses, adjusting for patient and hospital factors and annual CSF shunt procedure volume, were performed to evaluate the effects of race and payer status on the likelihood of inpatient mortality and nonroutine hospital discharge (that is, not to home). RESULTS African American patients (p < 0.05) had an increased likelihood of inpatient death and nonroutine discharge compared with white patients. Furthermore, Medicaid patients had a significantly higher likelihood of nonroutine discharge (p < 0.05) as compared with privately insured patients. CONCLUSIONS Findings in this study, which utilized US population-level data, suggest the presence of racial and socioeconomic status outcome disparities following pediatric CSF shunting procedures. Further studies on health disparities in this population are warranted.
authors: Departments of 1Neurosurgery.
authors: Frank J
authors: FJ
authors: Attenello
authors: 2Preventive Medicine.
authors: Alvin
authors: A
authors: Ng
authors: 3Keck School of Medicine of University of Southern California, Los Angeles, California.
authors: Timothy
authors: T
authors: Wen
authors: 4Neurology, and.|5Radiology, Keck School of Medicine of University of Southern California;
authors: Steven Y
authors: SY
authors: Cen
authors: 4Neurology, and.
authors: Nerses
authors: N
authors: Sanossian
authors: Departments of 1Neurosurgery.
authors: Arun P
authors: AP
authors: Amar
authors: Departments of 1Neurosurgery.
authors: Gabriel
authors: G
authors: Zada
authors: Departments of 1Neurosurgery.|6Division of Neurosurgery, Children's Hospital of Los Angeles.
authors: Mark D
authors: MD
authors: Krieger
authors: Departments of 1Neurosurgery.|6Division of Neurosurgery, Children's Hospital of Los Angeles.
authors: J Gordon
authors: JG
authors: McComb
authors: Departments of 1Neurosurgery.
authors: William J
authors: WJ
authors: Mack
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: KID = Kids' Inpatient Database; SES = socioeconomic status; hydrocephalus; inpatient death; neurosurgery; outcomes; routine discharge