Evaluating the Relationship Between Entry to Craniosynostosis Care and Neighborhood-level Socioeconomic Vulnerability

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Timely referral and surgical treatment are critical to optimizing outcomes in children with craniosynostosis (CS). Neighborhood-level socioeconomic status (SES) indices, including the Child Opportunity Index (COI), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI), quantify structural resources that may influence access to care. The objective of this study was to evaluate whether neighborhood-level SES is associated with referral patterns, travel burden, and timing of key milestones in the early CS care pathway.

Methods: A retrospective cohort study was conducted on 268 patients with CS treated within a tertiary craniofacial referral network. SES measures were assigned using 2020 COI, national ADI, and SVI scores based on patient residence. Outcomes included ages at referral, diagnosis, first plastic surgery consultation, and surgery, as well as time intervals between these milestones. Travel distance and time to care were calculated from patient residence to the surgical center. Continuous variables are reported as median (IQR). Univariable and multivariable linear regression analyses were performed, with p < 0.05 considered statistically significant.

Results: The cohort was 71.3% male, 81.7% White, and 86.9% Non-Hispanic; 66.0% had private insurance and 30.6% public insurance. Median ages were 2.9 months at referral, 3.0 months at diagnosis, 3.3 months at first consultation, and 5.2 months at surgery. Median intervals were 0.4 months from referral to consultation, 0.4 months from consultation to diagnosis, and 2.6 months from diagnosis to surgery. Higher COI scores were associated with shorter travel distance (p = 0.027) and time to care (p = 0.039). ADI and SVI were not associated with timing outcomes (p > 0.05). Pediatrician and Pediatric Neurosurgery referrals were associated with shorter referral-to-consultation intervals (p = 0.007). Multivariable analysis demonstrated no significant association between SES indices and timing of care milestones (p > 0.05).

Conclusion: Median ages and intervals for CS care were consistent with recommended timing. Patients from lower-opportunity neighborhoods had greater travel burden, but this did not translate into delays in early CS care. Referral provider specialty may influence time to initial consultation. Neighborhood-level SES vulnerability was not associated with clinically meaningful delays within this referral network.

Volume

14

Issue

Suppl 4

First Page

7

Last Page

7

Comments

Michigan Academy of Plastic Surgeons 34th Biennial Scientific Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276692.75139.bc

ISSN

2169-7574

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