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DISPARITIES IN ACCESS TO US CRANIOFACIAL CENTERS FOR NEWLY DIAGNOSED CRANIOSYNOSTOSIS: THE INFLUENCES OF URBAN VERSUS RURAL RESIDENCE AND PRIVATE VERSUS GOVERNMENT INSURANCE
J goldstein, Hannah Miller.
Children's Mercy Hospital, KANSAS CITY, MO, USA.

PURPOSE: The aim of this study is to assess disparity in access for craniosynostosis surgery for a single Midwestern United States craniofacial center in 2018 with an emphasis upon insurance status and urban versus local residence.
METHODS: The charts of all patients who underwent primary craniosynostosis repair in 2018 at our institution were reviewed for demographic factors, age at consultation, and surgical technique.
RESULTS: 54 patients, ages 2 to 22 months, underwent primary craniosynostosis surgery at our institution in 2018. 34 underwent an open procedure, while 20 underwent a strip craniectomy, followed by helmeting. 28 patients had private insurance (52%); 24 patients had state-funded medicaid insurance (44%), and 2 were without insurance (4%). 29 patients lived in an urban environment (54%); 25 resided rurally (46%). Further results include:
1. While 52% of patients were privately-insured, 72% of patients who underwent strip craniectomy were privately-insured. 28% were Medicaid/ uninsured.
2. While 54% of patients were urban-based, 74% of patients who underwent strip craniectomy were urban-based. 26% were rural.
3. For strip craniectomy patients, those privately-insured were first seen in consultation at a mean of 42 days of life. With Medicaid or uninsured, it was 58 days of life.
4. For insured urban-based strip craniectomy patients, mean day of first consultation was 37 days. If rural-based, the mean was 57 days.
CONCLUSION: Disparities in 2018 health care access for US craniosynostosis patients exist with delayed presentation for less-insured and/or rural patients as well as fewer strip craniectomy procedures in these patients.


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