title: Mortality of Dandy-Walker syndrome in the United States: Analysis by race, gender, and insurance status.
abstract: BACKGROUND
  Dandy-Walker syndrome (DWS) is a congenital disorder often diagnosed in early childhood. Typically manifesting with signs/symptoms of increased intracranial pressure, DWS is catastrophic unless timely neurosurgical care can be administered via cerebrospinal fluid (CSF) drainage. The rates of mortality, adverse discharge disposition (ADD), and CSF drainage in DWS may not be uniform regardless of race, gender or insurance status; such differences could reflect disparities in access to neurosurgical care. This study examines these issues on a nationwide level.
  
  
  METHODS
  The Kids' Inpatient Database spanning 1997-2003 was used for analysis. Only patients admitted for DWS (ICD-9-CM = 742.3) were included. Multivariate analysis was adjusted for several variables, including patient age, race, sex, admission type, primary payer, income, and hospital volume.
  
  
  RESULTS
  More than 14,000 DWS patients were included. Increasing age predicted reduced mortality (OR = 0.87; P < 0.05), ADD (OR = 0.96; P < 0.05), and decreased likelihood of receiving CSF drainage (OR = 0.86; P < 0.0001). Elective admission type predicted reduced mortality (OR = 0.29; P = 0.0008), ADD (OR = 0.68; P < 0.05), and increased CSF drainage (OR = 2.02; P < 0.0001). African-American race (OR = 1.20; P < 0.05) and private insurance (OR = 1.18; P < 0.05) each predicted increased likelihood of receiving CSF drainage, but were not predictors of mortality or ADD. Gender, income, and hospital volume were not significant predictors of DWS outcome.
  
  
  CONCLUSIONS
  Increasing age and elective admissions each decrease mortality and ADD associated with DWS. African-American race and private insurance status increase access to CSF drainage. These findings contradict previous literature citing African-American race as a risk factor for mortality in DWS, and emphasize the role of private insurance in obtaining access to potentially lifesaving operative care.
authors.affiliation: Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.affiliation: Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, USA.
authors.forename: Onyinyechi I
authors.initials: OI
authors.lastname: Ukwuoma
authors.affiliation: Biostatistics Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Lunos
authors.affiliation: Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA ; Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Kolawole S
authors.initials: KS
authors.lastname: Okuyemi
keywords: Congenital hydrocephalus; Dandy-Walker syndrome; healthcare disparities; mortality