Abstract：
OBJECTIVE: Fetal surgery for myelomeningocele has become an established treatment that offers less risk of requiring a ventricular shunt and improved functional outcomes for patients. An increasing body of literature has suggested that social determinants of health have a profound influence on health outcomes. The authors sought to determine the socioeconomic and racial and ethnic backgrounds of patients who were treated with fetal surgery versus those who underwent postnatal repair.
METHODS: Demographic data, the method of myelomeningocele repair, insurance status, and zip code data for patients entered into the National Spina Bifida Patient Registry (NSBPR) from Children\'s Wisconsin were collected. The zip code was used to determine the Distressed Communities Index (DCI) score, a composite socioeconomic ranking with scores ranging from 0 (no distress) to 100 (severe distress). The zip code was also used to determine the median household income for each patient based on the US Census Bureau 2013-2017 American Community Survey 5-year estimates.
RESULTS: A total of 205 patients were identified with zip code and insurance data. There were 23 patients in the fetal surgery group and 182 patients in the postnatal surgery group. All patients were born between 2000 and 2019. Patients in the fetal surgery group were more likely to have commercial insurance (100% vs 52.2%, p < 0.001). Fetal surgery patients were also more likely to be non-Hispanic White (95.7% vs 68.7%, p = 0.058), just missing the level of statistical significance. Patients who underwent fetal surgery tended to reside in zip codes with a higher median household income (mean $66,507 vs $59,133, p = 0.122) and less-distressed communities (mean DCI score 31.3 vs 38.5, p = 0.289); however, these differences did not reach statistical significance.
CONCLUSIONS: Patients treated with fetal surgery were more likely to have commercial insurance and have a non-Hispanic White racial and ethnic background. The preliminary data suggest that socioeconomic and racial and ethnic disparities may exist regarding access to fetal surgery, and investigation of a larger population of spina bifida patients is warranted.
METHODS: Demographic data, the method of myelomeningocele repair, insurance status, and zip code data for patients entered into the National Spina Bifida Patient Registry (NSBPR) from Children\'s Wisconsin were collected. The zip code was used to determine the Distressed Communities Index (DCI) score, a composite socioeconomic ranking with scores ranging from 0 (no distress) to 100 (severe distress). The zip code was also used to determine the median household income for each patient based on the US Census Bureau 2013-2017 American Community Survey 5-year estimates.
RESULTS: A total of 205 patients were identified with zip code and insurance data. There were 23 patients in the fetal surgery group and 182 patients in the postnatal surgery group. All patients were born between 2000 and 2019. Patients in the fetal surgery group were more likely to have commercial insurance (100% vs 52.2%, p < 0.001). Fetal surgery patients were also more likely to be non-Hispanic White (95.7% vs 68.7%, p = 0.058), just missing the level of statistical significance. Patients who underwent fetal surgery tended to reside in zip codes with a higher median household income (mean $66,507 vs $59,133, p = 0.122) and less-distressed communities (mean DCI score 31.3 vs 38.5, p = 0.289); however, these differences did not reach statistical significance.
CONCLUSIONS: Patients treated with fetal surgery were more likely to have commercial insurance and have a non-Hispanic White racial and ethnic background. The preliminary data suggest that socioeconomic and racial and ethnic disparities may exist regarding access to fetal surgery, and investigation of a larger population of spina bifida patients is warranted.
摘要：
目的：胎儿手术治疗脊髓膜膨出已成为一种成熟的治疗方法，可降低需要心室分流的风险，改善患者的功能预后。越来越多的文献表明，健康的社会决定因素对健康结果具有深远的影响。作者试图确定接受胎儿手术治疗的患者与接受产后修复的患者的社会经济，种族和种族背景。
方法：人口统计数据，脊髓膜膨出修复的方法,保险状况,收集了来自威斯康星州儿童的国家脊柱裂患者登记处（NSBPR）的患者的邮政编码数据。邮政编码用于确定贫困社区指数（DCI）得分，综合社会经济排名，得分从0（无困扰）到100（严重困扰）。邮政编码还用于根据美国人口普查局2013-2017年美国社区调查5年估计确定每位患者的家庭收入中位数。
结果：共有205名患者通过邮政编码和保险数据进行了鉴定。胎儿手术组23例，产后手术组182例。所有患者均出生在2000年至2019年之间。胎儿手术组的患者更有可能购买商业保险(100%vs52.2%，p<0.001)。胎儿手术患者也更可能是非西班牙裔白人（95.7％vs68.7％，p=0.058),只是缺少统计意义的水平。接受胎儿手术的患者倾向于居住在邮政编码中，家庭收入中位数较高（平均66,507美元vs59,133美元，p=0.122），社区较少困扰（平均DCI得分31.3vs38.5，p=0.289）；然而，这些差异没有达到统计学意义.
结论：接受胎儿手术治疗的患者更可能有商业保险，并且具有非西班牙裔白人种族和族裔背景。初步数据表明，在接受胎儿手术方面可能存在社会经济、种族和族裔差异，并且有必要对更多的脊柱裂患者进行调查。
方法：人口统计数据，脊髓膜膨出修复的方法,保险状况,收集了来自威斯康星州儿童的国家脊柱裂患者登记处（NSBPR）的患者的邮政编码数据。邮政编码用于确定贫困社区指数（DCI）得分，综合社会经济排名，得分从0（无困扰）到100（严重困扰）。邮政编码还用于根据美国人口普查局2013-2017年美国社区调查5年估计确定每位患者的家庭收入中位数。
结果：共有205名患者通过邮政编码和保险数据进行了鉴定。胎儿手术组23例，产后手术组182例。所有患者均出生在2000年至2019年之间。胎儿手术组的患者更有可能购买商业保险(100%vs52.2%，p<0.001)。胎儿手术患者也更可能是非西班牙裔白人（95.7％vs68.7％，p=0.058),只是缺少统计意义的水平。接受胎儿手术的患者倾向于居住在邮政编码中，家庭收入中位数较高（平均66,507美元vs59,133美元，p=0.122），社区较少困扰（平均DCI得分31.3vs38.5，p=0.289）；然而，这些差异没有达到统计学意义.
结论：接受胎儿手术治疗的患者更可能有商业保险，并且具有非西班牙裔白人种族和族裔背景。初步数据表明，在接受胎儿手术方面可能存在社会经济、种族和族裔差异，并且有必要对更多的脊柱裂患者进行调查。
