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Sociodemographic disparities in fetal surgery for myelomeningocele: a single-center retrospective review. J Neurosurg Pediatr 2021 Dec 24:1-5

Date

12/25/2021

Pubmed ID

34952526

DOI

10.3171/2021.7.PEDS20836

Scopus ID

2-s2.0-85127533912   1 Citation

Abstract

OBJECTIVE: Fetal surgery for myelomeningocele has become an established treatment that offers less risk of requiring a ventricular shunt and improved functional outcomes for patients. An increasing body of literature has suggested that social determinants of health have a profound influence on health outcomes. The authors sought to determine the socioeconomic and racial and ethnic backgrounds of patients who were treated with fetal surgery versus those who underwent postnatal repair.

METHODS: Demographic data, the method of myelomeningocele repair, insurance status, and zip code data for patients entered into the National Spina Bifida Patient Registry (NSBPR) from Children's Wisconsin were collected. The zip code was used to determine the Distressed Communities Index (DCI) score, a composite socioeconomic ranking with scores ranging from 0 (no distress) to 100 (severe distress). The zip code was also used to determine the median household income for each patient based on the US Census Bureau 2013-2017 American Community Survey 5-year estimates.

RESULTS: A total of 205 patients were identified with zip code and insurance data. There were 23 patients in the fetal surgery group and 182 patients in the postnatal surgery group. All patients were born between 2000 and 2019. Patients in the fetal surgery group were more likely to have commercial insurance (100% vs 52.2%, p < 0.001). Fetal surgery patients were also more likely to be non-Hispanic White (95.7% vs 68.7%, p = 0.058), just missing the level of statistical significance. Patients who underwent fetal surgery tended to reside in zip codes with a higher median household income (mean $66,507 vs $59,133, p = 0.122) and less-distressed communities (mean DCI score 31.3 vs 38.5, p = 0.289); however, these differences did not reach statistical significance.

CONCLUSIONS: Patients treated with fetal surgery were more likely to have commercial insurance and have a non-Hispanic White racial and ethnic background. The preliminary data suggest that socioeconomic and racial and ethnic disparities may exist regarding access to fetal surgery, and investigation of a larger population of spina bifida patients is warranted.

Author List

Foy AB, Sawin KJ, Derflinger T, Heffelfinger AK, Koop JI, Cohen SS, Sherburne EC

Authors

Susan Cohen MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Andrew Foy MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
Amy Heffelfinger PhD Professor in the Neurology department at Medical College of Wisconsin
Jennifer I. Koop Olsta PhD Professor in the Neurology department at Medical College of Wisconsin