title: Racial, Socioeconomic, and Gender Disparities in the Presentation, Treatment, and Outcomes of Adult Chiari I Malformations.
abstract: OBJECTIVE
  To examine the influence of race, gender, and socioeconomic factors on presentations and outcomes of adult Chiari I malformations.
  
  
  METHODS
  The charts of 638 adult patients with Chiari I malformations were reviewed, and 287 patients were included in the study. Race, gender, insurance status, symptoms, depth of cerebellar tonsillar herniation, and presence of syringomyelia were examined as covariates in multivariate logistic regression models to identify independent predictors of presentation and outcome.
  
  
  RESULTS
  Patients with public insurance had a longer stay in the hospital (P = 0.01). A higher proportion of male patients presented with upper extremity weakness (P = 0.01), lower extremity weakness (P = 0.040), and cranial nerve findings (P = 0.02). Men had shorter onset to diagnosis times (P = 0.02), worse tonsillar herniation (P = 0.03), and more severe symptoms (P = 0.05). White patients more frequently presented with back pain (P = 0.03), and African American patients more frequently presented with lower extremity weakness (P = 0.01). African Americans had worse tonsillar herniation (P < 0.01) and were more likely to present with syringomyelia (P = 0.01). Multivariate regression analysis revealed that back pain (P < 0.01), upper extremity weakness (P ≤ 0.01), upper extremity paresthesias (P < 0.01), and upper with lower extremity paresthesias (P = 0.04) were significant predictors of syringomyelia. The only independent predictor of outcome was size of tonsillar herniation (P = 0.03).
  
  
  CONCLUSIONS
  Significant differences in presentation of Chiari I malformation resulting from gender, race, and insurance status were quantified for the first time.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: Max.Krucoff@duke.edu.
authors.forename: Max O
authors.initials: MO
authors.lastname: Krucoff
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Cook
authors.affiliation: Department of Neurosurgery, Rush Medical Center, Chicago, Illinois, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Moreno
authors.affiliation: Department of Biostatistics, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Siyun
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Biostatistics, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Jichun
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Buncke Clinic, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Alexander O
authors.initials: AO
authors.lastname: Firempong
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Nandan
authors.initials: N
authors.lastname: Lad
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000628:therapy*; D015276:Health Care Rationing / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina / Q000208:ethnology; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D063507:Sexism; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adult Chiari malformation; Chiari I malformation; Economic disparity; Gender disparity; Racial disparity; Socioeconomic disparity