237. Socioeconomic and Demographic Determinants of Care for Asymptomatic and Symptomatic Chiari I Malformation With or Without Syringomyelia

Authors: Syed Hassan Abbas Akbari, MD; Irina Gonzalez-Sigler; Anastasia Arynchyna; James Johnston, MD; Curtis Rozzelle, MD; Jeffrey Blount, MD; Jerry Oakes, MD; Brandon Rocque, MD (Birmingham, AL)

Introduction:

There is little research on the socioeconomic determinants of care for Chiari I malformation (CM-1). In this study, we analyze all children evaluated for CM-1 at Children’s Hospital of Alabama (COA) using measures of socioeconomic disadvantage.

Methods:

Medical records of patients treated for CM-1 at COA between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes were collected for each patient as measures of local disadvantage.

Results:

997 CM-1 patients were identified. 706 (82.8%) patients were white and 147 (17.2%) were non-white (NW). Private insurance was more common for white versus NW patients (74.3% vs 54.4%; p<0.001). After controlling for age, gender, and insurance status, white patients had higher RUCA scores (less likely to be from metropolitan areas) (p<0.001) and lower ADI scores (lower disadvantage) compared to NW patients (p<0.001). 307 (30.8%) patients underwent surgery. Non-white and white patients had similar surgery rates (33.3% vs 29.3%, p=0.373). Surgical versus nonsurgical patients had similar ADI and RUCA scores. NW patients had larger syringes by transverse diameter (7.7 vs 4.7mm, p=0.005). NW patients were more likely to have a syrinx compared to white patients (27.2% vs 19.4%, p=0.034). Among operative patients, NW patients had higher rates of syrinx (81.6% vs 66.2%, p=0.035) and tended towards a higher reoperation rate (16.3% vs 8.2%, p=0.085). 48 patients who were initially asymptomatic required subsequent surgery. 44 (91.7%) were white and 4 (8.3%) were NW. Of these patients, NW patients had a higher ADI compared to white patients (Median 7.0 vs 4.0, p=0.019).

Conclusion:

While NW patients were more likely to be disadvantaged, race and disadvantage were not correlated with undergoing surgical treatment. However, white race and greater area advantage did show correlation with initially non-operative patients obtaining delayed decompression. This may reflect barriers to follow up care.