Background

Early specialist evaluation during rapid proliferative growth of complicated infantile hemangiomas (IHs) is crucial. Health disparities and barriers of access to care for children with IHs have not been examined.

Objective

To investigate whether socioeconomic status (SES) is associated with age at presentation to a subspecialist for IH evaluation.

Method

A retrospective cohort study of 804 children presenting to a large academic hospital. The primary outcome was age at initial presentation. Covariates included demographic, socioeconomic, geographic, and clinical characteristics. Medicaid and the Children’s Health Insurance Program were proxies for lower SES. Analysis of covariance, chi-square tests, and generalized ordered logistic regressions were performed.

Results

Children with lower SES had higher odds of presenting after 3 months of age (odds ratio, 2.11; 95% confidence interval, 1.31-3.38). In the subset that qualified for the institutional care management program (ICMP), no risk factors were associated with delayed presentation.

Limitations

Use of insurance and economic distress as proxies for SES; exclusion of uninsured children, which may have resulted in underestimation of racioethnic effects; and examination of a single academic center, which may limit generalizability.

Conclusions

Children with IHs and lower SES were more likely to present later to specialists, but those enrolled in an ICMP were not, suggesting that integrated ICMPs may mitigate disparities and delayed access to care for IHs among lower-SES populations.

中文翻译：

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较低的社会经济地位与延迟获得婴儿血管瘤护理有关：一项队列研究

背景

在复杂性婴儿血管瘤 (IH) 的快速增殖生长过程中，早期专家评估至关重要。尚未研究 IH 儿童的健康差异和获得护理的障碍。

客观的

调查社会经济地位 (SES) 是否与就诊时年龄相关，以进行 IH 评估。

方法

一项针对 804 名就诊于大型学术医院的儿童的回顾性队列研究。主要结果是初次就诊时的年龄。协变量包括人口统计学、社会经济、地理和临床特征。医疗补助计划和儿童健康保险计划是较低社会经济地位的代表。进行了协方差分析、卡方检验和广义有序逻辑回归。

结果

SES 较低的儿童在 3 个月大后出现的几率较高（优势比，2.11；95% 置信区间，1.31-3.38）。在符合机构护理管理计划 (ICMP) 资格的子集中，没有风险因素与延迟就诊相关。

限制

使用保险和经济困难作为 SES 的代理；将没有保险的儿童排除在外，这可能导致低估种族影响；和单个学术中心的考试，这可能会限制普遍性。

结论

患有 IH 和较低 SES 的儿童更有可能在以后向专家求诊，但那些参加 ICMP 的儿童则不然，这表明综合 ICMP 可以减轻较低 SES 人群中的差异和延迟获得 IH 护理的机会。