The Impact of Socioeconomic Disadvantage on Patient Adherence to Longitudinal Multi-Specialty Craniosynostosis Care

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Craniosynostosis (CS) is a complex congenital condition that requires longitudinal care across multiple specialties, including plastic surgery, neurosurgery, and ophthalmology. Consistent follow-up is critical for monitoring cranial growth, guiding surgical planning, and managing surgical or CS-related complications. Coordinating care across multiple specialties pose logistical challenges and can burden caregivers, resulting in decreased appointment adherence which has the potential to delay care and compromise clinical outcomes. Socioeconomic disadvantage is a well-established barrier to healthcare access that may compound risk for incomplete follow-up. This study aims to evaluate whether one marker of neighborhood-level socioeconomic disadvantage, Area Deprivation Index (ADI), is associated with risk for decreased appointment adherence in CS care.

A retrospective review was conducted on 252 patients with non-syndromic CS who underwent cranial vault reconstruction (CVR) between 2010-2024 at our institution. Patients with a non-Michigan address or suppressed ADI (e.g., group living, small population) were excluded. Data collected included patient demographics, number of appointments per specialty per appointment status (completed, cancelled, or no-show/missed), patient-reported reasons for cancellations, and completion status of the standard four plastic surgery CVR follow- up visits. Only in-person appointments with plastic surgery, neurosurgery, and ophthalmology were recorded. Associations were evaluated via Mann-Whitney U tests with significance evaluated as a p-value over 0.05. Continuous variables are non-normal and presented as median [interquartile range].

Patients were 3.7 [1.7, 8.4] months old at CS diagnosis and 5.8 [4.7, 11.9] months at CVR. Median national ADI for the cohort was 60 [48, 75]. On average, patients completed 7 [6, 10] appointments with plastic surgery, 3 [2, 5] with neurosurgery, and 4 [2, 7] with ophthalmology. ADI was inversely related to the number of completed plastics (p< 0.01) and ophthalmology (p=0.02) appointments but not neurosurgery (p=0.64). ADI was directly related to the number of no-shows in all specialties (all p< 0.05), but significance was lost to insurance and race on multivariable analysis. Patients with lower ADIs (i.e., less deprivation) established plastics care earlier (p=0.02). ADI was not associated with cancellations, reasons for cancellations, age at diagnosis, time between diagnosis and CVR, or adherence to 2-week, 1- year, or initial multidisciplinary craniofacial clinic follow-up from CVR (all p>0.05).

Higher ADI, or greater area-level socioeconomic deprivation, is associated with decreased adherence to long-term multidisciplinary care in CS and could be used to proactively identify patient risk for non-adherence. These findings underscore the importance of incorporating socioeconomic context into longitudinal coordinated care and strategizing healthcare access for disadvantaged patients. Future work may explore telehealth or satellite clinics in such a role.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2009

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