Lower Socioeconomic Status is Associated with Delayed Access to Care for Infantile Hemangioma, a Cohort Study

Publication date: Available online 1 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Erina Lie, Kevin J. Psoter, Katherine B. Püttgen

ABSTRACT

Background

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

Objective

Investigate whether socioeconomic status (SES) is associated with age at subspecialist presentation for IH evaluation.

Method

Retrospective cohort study of 804 children presenting to a large academic hospital. Primary outcome was age at initial presentation. Covariates included demographic, socioeconomic, geographic, and clinical characteristics. Medicaid or Children's Health Insurance Program (CHIP) were proxies for lower SES. Analysis of covariance, χ2 tests, and generalized ordered logistic regressions were performed.

Results

Children with lower SES had higher odds of presenting after 3 months of age (OR 2.11, 95% CI 1.31-3.38). In the subset that qualified for 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 may underestimate racioethnic effects; single academic center study limiting generalizability.

Conclusions

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

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