Race Is Associated With Delayed Diagnosis of Sagittal Craniosynostosis: A Single-Institutional Retrospective Study

Abstract

Objective

Identify factors associated with delayed diagnosis of sagittal craniosynostosis.

Design

Retrospective cohort study.

Setting

Single institution tertiary care center over 10 years.

Patients

Ninety-one patients diagnosed with sagittal craniosynostosis.

Interventions

Variables collected included sex, race, ethnicity, age at diagnosis, insurance type, distance traveled, community designation and Area Deprivation Index (ADI), cephalic index (CI), and prematurity (birth at gestational age < 37 weeks). Statistical analysis was performed using Fisher exact test, Wilcoxon-sum test, and multivariable logistic regression.

Main Outcome Measure(s):

Age at diagnosis and factors associated with delayed diagnosis (>6 months of age).

Results

On univariable analysis, diagnosis >6 months of age was associated with a greater proportion of non-Hispanic black patients (44% vs 8%, P < .001) and a smaller proportion of non-Hispanic white patients (39% vs 79%, P < .001). A greater proportion of patients had CI ≥ 75 (55% vs 6%, P < .001), and a greater proportion of patients had public insurance (68% vs 38%, P = .008). On multivariable logistic regression non-Hispanic black patients were nearly 7 times more likely compared to non-Hispanic white patients to experience delayed diagnosis when controlling for national (OR 6.96, P = .018) or state ADI (OR 6.51, P = .039).

Conclusion

After adjusting for multiple clinical and sociodemographic factors including insurance type and CI, black patients were nearly 7 times more likely than white patients to experience delayed diagnosis of sagittal craniosynostosis. Future studies are needed to identify modifiable factors contributing to this diagnosis gap and identify opportunities to close it.