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.
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