Abstract：
BACKGROUND: Healthcare inequity is a pressing concern in pediatric populations with craniofacial conditions. Little is known about the barriers to care affecting children with craniosynostosis. This systematic review investigates disparities impacting care for children with craniosynostosis in the U.S.
METHODS: A comprehensive literature search was performed in the following databases from inception to December 2022: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies were screened for eligibility by two authors. All original articles that focused on disparities in access, treatment, or outcomes of craniosynostosis surgery were included. Studies describing disparities in other countries, those not written English, and review articles were excluded (Figure 1).
RESULTS: An initial database search revealed 607 citations of which 21 met inclusion criteria (Figure 1). All included studies were retrospective reviews of databases or cohorts of patients. The results of our study demonstrate that barriers to access in treatment for craniosynostosis disproportionally affect minority children, children of non-English speaking parents and those of lower socioeconomic status or with Medicaid. Black and Hispanic children, non-English speaking patients, and children without insurance or with Medicaid were more likely to present later for evaluation, ultimately undergoing surgery at an older age. These patients were also more likely to experience complications and require blood transfusions compared to their more privileged, white peers.
CONCLUSIONS: There is a discrepancy in treatment received by minority patients, patients with Medicaid, and those who are non-English speaking. Further research is needed to describe the specific barriers that prevent equitable care for these patients.
METHODS: A comprehensive literature search was performed in the following databases from inception to December 2022: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies were screened for eligibility by two authors. All original articles that focused on disparities in access, treatment, or outcomes of craniosynostosis surgery were included. Studies describing disparities in other countries, those not written English, and review articles were excluded (Figure 1).
RESULTS: An initial database search revealed 607 citations of which 21 met inclusion criteria (Figure 1). All included studies were retrospective reviews of databases or cohorts of patients. The results of our study demonstrate that barriers to access in treatment for craniosynostosis disproportionally affect minority children, children of non-English speaking parents and those of lower socioeconomic status or with Medicaid. Black and Hispanic children, non-English speaking patients, and children without insurance or with Medicaid were more likely to present later for evaluation, ultimately undergoing surgery at an older age. These patients were also more likely to experience complications and require blood transfusions compared to their more privileged, white peers.
CONCLUSIONS: There is a discrepancy in treatment received by minority patients, patients with Medicaid, and those who are non-English speaking. Further research is needed to describe the specific barriers that prevent equitable care for these patients.
摘要：
背景：在患有颅面疾病的儿科人群中，医疗保健不平等是一个紧迫的问题。关于影响颅骨融合症儿童的护理障碍知之甚少。本系统综述调查了影响美国颅骨融合症儿童护理的差异
方法：从开始到2022年12月，在以下数据库中进行了全面的文献检索：OvidMEDLINE，OvidEmbase,科克伦图书馆两位作者对研究进行了资格筛选。所有关注获取差异的原创文章，治疗,或包括颅骨融合手术的结果.描述其他国家差异的研究，那些没有写英语的人，和评论文章被排除在外(图1)。
结果：最初的数据库搜索显示607条引用，其中21条符合纳入标准（图1）。所有纳入的研究都是对数据库或患者队列的回顾性回顾。我们的研究结果表明，颅骨融合症治疗的障碍不成比例地影响少数民族儿童，非英语父母和社会经济地位较低或有医疗补助的孩子。黑人和西班牙裔儿童，非英语患者,没有保险或有医疗补助的孩子更有可能在以后出现评估，最终在年龄较大的时候接受手术。与他们的特权相比，这些患者更容易出现并发症，需要输血。白人同行
结论：少数民族患者接受的治疗存在差异，医疗补助患者,和那些不讲英语的人。需要进一步的研究来描述阻止这些患者公平护理的具体障碍。
方法：从开始到2022年12月，在以下数据库中进行了全面的文献检索：OvidMEDLINE，OvidEmbase,科克伦图书馆两位作者对研究进行了资格筛选。所有关注获取差异的原创文章，治疗,或包括颅骨融合手术的结果.描述其他国家差异的研究，那些没有写英语的人，和评论文章被排除在外(图1)。
结果：最初的数据库搜索显示607条引用，其中21条符合纳入标准（图1）。所有纳入的研究都是对数据库或患者队列的回顾性回顾。我们的研究结果表明，颅骨融合症治疗的障碍不成比例地影响少数民族儿童，非英语父母和社会经济地位较低或有医疗补助的孩子。黑人和西班牙裔儿童，非英语患者,没有保险或有医疗补助的孩子更有可能在以后出现评估，最终在年龄较大的时候接受手术。与他们的特权相比，这些患者更容易出现并发症，需要输血。白人同行
结论：少数民族患者接受的治疗存在差异，医疗补助患者,和那些不讲英语的人。需要进一步的研究来描述阻止这些患者公平护理的具体障碍。
