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Racial, Socioeconomic, and Gender Disparities in the Presentation, Treatment, and Outcomes of Adult Chiari I Malformations. World Neurosurg 2017 Jan;97:431-437

Date

10/19/2016

Pubmed ID

27751919

DOI

10.1016/j.wneu.2016.10.026

Scopus ID

2-s2.0-84994627705 (requires institutional sign-in at Scopus site)   21 Citations

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.

Author List

Krucoff MO, Cook S, Adogwa O, Moreno J, Yang S, Xie J, Firempong AO, Lad N, Bagley CA

Author

Max O. Krucoff MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Arnold-Chiari Malformation
Health Care Rationing
Health Services Accessibility
Healthcare Disparities
Humans
Insurance Coverage
Middle Aged
North Carolina
Racism
Risk Factors
Sex Distribution
Sexism
Socioeconomic Factors
Treatment Outcome
Young Adult