Systematic review of racial, socioeconomic, and insurance status disparities in the treatment of pediatric neurosurgical pathologies in the United States.

ABSTRACT Background Increasing light is being shed on how race, insurance, and socioeconomic status may be related to outcomes from disease in the United States. In order to better understand the impact of these healthcare disparities in the field of pediatric neurosurgery, we performed a systematic review of the current literature. Methods We conducted a systematic review using PRISMA guidelines and MeSH terms involving neurosurgical conditions and racial, ethnic, and socioeconomic status (SES) disparities. Three independent reviewers screened articles and analyzed texts selected for full analysis. Results Thirty-eight studies were included in the final analysis, of which all but two were retrospective database reviews. Thirty-four studies analyzed race, 22 analyzed insurance status, and 13 analyzed socioeconomic status/income. Overall, nonwhite patients, patients with public insurance, and patients from lower SES were shown to have reduced access to treatment and greater rates of adverse outcomes. Most notably, nonwhite patients were more likely to present at an older age with more severe disease, less likely to undergo surgery at a high-volume surgical center, and more likely to experience postoperative morbidity and mortality. Underinsured and publicly insured patients were more likely to experience delay in surgical referral, less likely to undergo surgical treatment, and more likely to experience inpatient mortality. Conclusion Healthcare disparities are present within multiple populations of patients receiving pediatric neurosurgical care. This review highlights the need for continued investigation into identifying and addressing healthcare disparities in pediatric neurosurgery patients.