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069. Systematic review of racial, SOCIOECONOMIC, and insurance status disparities in the treatment of pediatric neurosurgical pathologies in the United States

Authors: Tyler Cardinal

Introduction:
Investigating healthcare disparities has become increasingly important since the release of a report in 2001 by the Institute of Medicine detailing the prevalence of healthcare inequities in the United States. However, less is known about healthcare disparities in children, particularly in neurosurgical populations. The objective of the present study was to perform a systematic review of healthcare disparities in the field of pediatric neurosurgery to better understand the impact on healthcare in children.Methods: We conducted a systematic review of the MEDLINE/PubMed and Embase databases using PRISMA guidelines and MeSH terms involving neurosurgical conditions and racial, ethnic, and SOCIOECONOMIC status (SES) disparities in children. Three independent reviewers screened articles and analyzed texts selected for full analysis.
Results:
Thirty-eight studies were included in the final analysis, of which all but two were retrospective database reviews. Thirty-four studies analyzed race, 22 analyzed insurance status, and 13 analyzed SOCIOECONOMIC status/income. Studies investigated disparities in access to pediatric neurosurgical care (10 studies), receipt of treatment or treatment center volume (9 studies), in-hospital outcomes (16 studies) and post-discharge outcomes (18 studies). Privately insured patients were more likely to receive surgical treatment, were less likely to die in the hospital and more likely to be discharged to home. Children from higher SES were more likely to undergo surgical treatment. Non-white children were more likely to experience in-hospital mortality and to have greater rates of overall mortality than non-whites. Post-discharge complications were not affected by insurance status in any of the studies we identified.
Conclusion:
Substantial healthcare disparities are present within pediatric neurosurgery. This review emphasizes the need for continued investigation into these disparities with a focus on solutions to address identified inequities.