Jul 2026· Journal of Neurosurgery: Pediatrics· pp. 1-12· 0 citations· 44 references
TL;DR
Exposure to environmental toxins and elevated neighborhood disadvantage are associated with worse outcomes in children with hydrocephalus and these results highlight social and environmental risk factors that warrant further investigation through biochemical or qualitative means.
Abstract
Previous research has identified an association of socioeconomic status with poor health outcomes related to the treatment of pediatric hydrocephalus. However, the impact of environmental exposures and neighborhood disadvantage remains unexplored. The authors sought to determine how these factors affect hydrocephalus outcomes.
This study is an analysis of prospectively collected registry data of pediatric hydrocephalus patients from 2008 to 2023 at a single institution. Geospatial analysis was conducted using the patient’s address at the time of the initial procedure for treatment of hydrocephalus. Socioeconomic status was quantified using the Area Deprivation Index (ADI), and environmental exposure data were obtained from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and satellite-derived ground-level fine particulate matter, linked to patients’ addresses using hospital administrative data. Multivariable Cox regressions with robust standard errors to adjust for clustering of area-level measures were utilized to assess the independent association of neighborhood and environmental factors with shunt revisions and complications.
In total, 881 patients who underwent primary shunt insertion for nontraumatic etiologies were included. The median (IQR) ADI percentile was 78 (61–90). The most common hydrocephalus etiology was intraventricular hemorrhage of prematurity (33%), followed by myelomeningocele (12%). At the latest follow-up, 48% of patients had experienced at least one shunt failure. The median (IQR) follow-up duration was 5.6 (1–11) years. In a multivariable Cox proportional hazards model, high ozone exposure areas (HR 1.38, 95% CI 1.05–1.82) and high ADI (HR 1.46, 95% CI 1.15–1.86) were independently associated with an increased risk of failure. High coal exposure was associated with an increased risk of shunt infection (HR 1.92, 95% CI 1.28–2.88). High PM
2.5
(particulate matter with a diameter ≤ 2.5 μm) was also significantly associated with increased all-cause mortality (HR 3.16, 95% CI 1.11–8.99).
Exposure to environmental toxins and elevated neighborhood disadvantage are associated with worse outcomes in children with hydrocephalus. Environmental exposure may increase inflammatory pathways in children and reflect poor socioeconomic status. These results highlight social and environmental risk factors that warrant further investigation through biochemical or qualitative means.
OBJECTIVE
Epilepsy surgery offers curative potential for refractory focal epilepsy, yet it remains underutilized, particularly among socioeconomically disadvantaged populations. In this study, we aim to explore the impact of socioeconomic status on timing and subsequently on outcomes of epilepsy surgery.
METHODS
This retrospective longitudinal cohort study analyzed 1027 patients who underwent epilepsy surgery at the Cleveland Clinic between 1997 and 2023, using the Area Deprivation Index to assess neighborhood-level socioeconomic status.
RESULTS
Findings revealed significant delays to surgery and worse baseline mental and physical health among patients from quintiles with lower neighborhood resources. Despite these disparities, seizure freedom (Engel class I) and postoperative improvements in quality of life and mental health were comparable across all socioeconomic strata.
SIGNIFICANCE
These results underscore the need for equitable access to epilepsy surgery and suggest that socioeconomic status should not delay or deter surgical referral, as outcomes remain robust across diverse populations. We also demonstrate that patients enter surgery on distinct health trajectories shaped by socioeconomic disadvantage, highlighting the need for early identification and intervention to maximize postoperative benefit.
R. Yardi, Alan J. Gordillo, H. Sancheti et al.· Epilepsia· 0 citations
OBJECTIVE
To compare the Area Deprivation Index (ADI) and Distressed Communities Index (DCI) in identifying socioeconomic disparities in 24-hour urine (24hU) parameters and stone composition among patients undergoing percutaneous nephrolithotomy (PCNL).
METHODS
Retrospectively, 1859 adults who underwent PCNL between 2017 and 2022 and completed at least one 24hU collection were included. Patients were assigned ADI and DCI percentiles based on residential location. Demographics, urine chemistries, categorical urine abnormalities, and stone composition were compared across index quartiles. Multivariable logistic regression adjusted for age, sex, race, and body mass index assessed associations between socioeconomic quartiles and urinary abnormalities or stone type. Predictive performance of ADI- and DCI-based models was compared using discrimination and non-nested model testing.
RESULTS
Greater socioeconomic deprivation was associated with younger age, higher body mass index, and lower completion of metabolic testing. Higher ADI quartiles were associated with lower urine volume, lower urinary potassium, increased odds of low urine volume, and hypocitraturia. DCI quartiles demonstrated similar associations with urine volume but were additionally associated with urinary oxalate and uric acid, while showing no significant association with hypocitraturia. ADI quartile 4 was associated with lower odds of calcium oxalate stones and higher odds of struvite and calcium phosphate stones, whereas DCI showed weaker associations with stone composition. For outcomes significantly associated with both indices, neither demonstrated superior predictive performance.
CONCLUSIONS
ADI and DCI identify complementary socioeconomic disparities in nephrolithiasis. ADI was more strongly associated with categorical urine abnormalities and stone composition, whereas DCI correlated more closely with continuous urine chemistries.
Jacob M. Knorr, G. Diaz, Delaney Ryan et al.· Urology· 0 citations
BACKGROUND
Socioeconomic disparities are a critical risk factor for poor health outcomes yet remain under investigated in the context of developmental dysplasia of the hip (DDH). Childhood Opportunity Index (COI) 3.0 is a composite index of socioeconomic resources available to a child. Few studies have leveraged COI to investigate social determinants of health and outcomes of DDH.
METHODS
A retrospective review of patients younger than 9 months who presented with ultrasonographic evidence of DDH and treated with a Pavlik harness from January 1, 2016, to July 1, 2023, at a single tertiary care orthopaedic hospital was conducted. Participants were stratified by high and low opportunity using nationally normed COI 3.0 quintiles. Demographic data, clinical presentation, and treatment outcomes were compared.
RESULTS
Two hundred eighty-seven patients with DDH treated with Pavlik harness were included; 194 and 93 patients were included in the high-COI and low-COI groups, respectively. Age at Pavlik harness initiation was not different between the low-COI (29.2 days ± 35.0) and high-COI groups (31.2 days ± 36.0, P = 0.66), nor was the proportion of patients presenting with bilateral DDH (63% versus 57%, respectively, P = 0.37). Per hip analysis demonstrated no difference in alpha angle at presentation between the low-COI (54.1° ± 6.7) and high-COI groups (53.6° ± 8.2, P = 0.54) or the percentage of dislocated hips (8% per group, P = > 0.99). The proportion of patients requiring rigid abduction orthosis after harness treatment was not different between the low-COI (18%) and high-COI groups (21%, P = 0.64) nor was the proportion of patients requiring surgical intervention (10% and 9%, respectively).
CONCLUSION
At a tertiary care, urban orthopaedic hospital, lower childhood opportunity index (COI) was not associated with age or severity of DDH at presentation, nor success in Pavlik harness treatment, aligning with our current understanding of DDH and COI. Despite racial and ethnic differences between high-COI and low-COI groups, individual patient outcomes remained similar.
Samuel A. Beber, O. Tracey, S. J. Ross et al.· Journal of the American Acad...· 0 citations
BACKGROUND
Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality. The influence of sociodemographic characteristics on adverse outcomes in adults hospitalized with CAP remains poorly understood, particularly for patients younger than 65.
OBJECTIVES
To evaluate associations between baseline sociodemographic characteristics and a composite outcome of intensive care unit (ICU) admission or in-hospital mortality, and whether these differed across age strata (18-39, 40-64, and ≥65 years).
METHODS
We conducted a multicentre, retrospective, cohort study of adults ≥18 years hospitalized with CAP between 2015 and 2024 in Ontario. Using generalized linear mixed models stratified by age, we evaluated the adjusted effects of clinical (i.e., comorbidity and illness severity) and sociodemographic characteristics (i.e., age, sex, four dimensions of neighborhood-level marginalization) with the composite outcome. We compared the contribution to model fit of these variable groups using nested likelihood ratio tests.
RESULTS
Among 84,356 hospitalizations, males had higher adjusted odds of the composite outcome across all age groups (adjusted odds ratio [aOR] range: 1.25-1.48), while residence in areas with higher concentrations of racialized/newcomer populations was associated with lower odds of the composite outcome (aOR range: 0.89-0.96). Nested likelihood ratio tests showed that clinical characteristics contributed substantially more to outcome variation than sociodemographic factors (χ2 1682 vs. 145 in the ≥65 stratum).
CONCLUSIONS
Sociodemographic and clinical characteristics were associated with severe CAP outcomes, but clinical factors accounted for a greater proportion of outcome variation. Incorporating sociodemographic information, including sex, age, and marginalization measures, into early assessment may improve identification of patients at higher risk.
Farhana Islam, S. Roberts, S. Malecki et al.· Journal of Hospital Medicine· 0 citations
Background Neighborhood socioeconomic status (nSES) is associated with heart failure (HF) outcomes but has not been investigated within a municipal public health system. Objectives The authors assessed the relationships between nSES index and HF-specific or all-cause hospital readmissions and all-cause mortality. Methods We conducted a retrospective electronic medical record-based cohort study of adults with International Classification of Diseases-9 or -10 diagnosis of HF; geocoded residential address; and index HF admission within a municipal public health system between January 2001 and September 2019. Kaplan-Meier analyses were used for time-to-event analyses. Fine-Gray Survival models were adjusted for demographics, comorbidities, substance use, guideline-directed medical therapy, and 30-day outpatient follow-up with random effects to account for correlation within census tracts. Results Among 2,440 individuals, the median age was 60.8 years (SD 14.8 years), 33.6% (821/2,440) were females, and 35.7% (870/2,440) self-identified as Black. The median follow-up time was 38.1 months (IQR: 16.2-74.1 months). The lowest nSES quintile had a 62% higher HF readmission risk (HR: 1.62; 95% CI: 1.09 to 2.41; P = 0.018) and 54% higher all-cause readmission risk (HR: 1.54; 95% CI: 1.17-2.02; P = 0.002) over 1 year than the highest nSES quintile. nSES was not associated with all-cause mortality. Geographic “hotspots” of index HF hospitalizations or all-cause readmissions occurred in neighborhoods disproportionately affected by historical redlining policies and single-room occupancy units. Conclusions Lower nSES is associated with higher HF-specific and all-cause readmission within a municipal hospital system. Future research should focus on improving HF morbidity for readmission “hotspot” neighborhoods.
Diane Jeon, M. Durstenfeld, Yifei Ma et al.· JACC: Advances· 0 citations
Social vulnerability index (SVI) has been used as a surrogate measure to assess social determinants of health (SDOH) when conducting health disparities research, but the impact of SVI on the timing, receipt, and outcomes of cataract care in a nationally representative population of patients is unknown. A retrospective observational cohort study of Medicare fee-for-service beneficiaries aged 66 + in 2014 without a prior diagnosis of cataract disease was conducted to determine who went on to develop cataract disease and undergo cataract surgery between 2014 and 2021. A Fine and Gray sub-distribution hazard model was used to determine the association between SVI quartile, time to diagnosis and time to cataract surgery. Logistic regression was used to assess the association between SVI quartile and the incidence of ophthalmic complications. Among 170,778 Medicare beneficiaries aged 66 + years of age at the start of the study period, 50.2% identified as female, 7.0% Black, 4.4% Hispanic, and 80.9% White. Fewer beneficiaries residing in high SVI (higher vulnerability) regions were diagnosed with cataracts (Quartile 4 55.9% vs. Q1 67.1%, p < 0.001) and underwent cataract surgery (Q4 19.4% vs. Q1 21.1%, p < 0.001) compared to beneficiaries in low SVI regions. After adjusting for patient demographics, overall health and frailty status, and health systemic characteristics including region, urban/rural location and number of ophthalmologists per capita, patients residing in higher SVI areas had lower rates of diagnosis (Q2 HR: 0.92 95% CI (0.91, 0.94); Q3 0.86 (0.84, 0.87); Q4: 0.78 (0.77, 0.80), reference=Q1) and cataract surgery (Q3 HR: 0.95, 95% CI (0.92, 0.98) and Q4: 0.90 (0.87, 0.93), respectively, reference=Q1). However, once a diagnosis was made, patients residing in higher SVI regions had higher rates of cataract surgery (Q2 HR: 1.04 (1.01, 1.07); Q3: 1.06 (1.03, 1.09); and Q4: 1.08 (1.05, 1.12), respectively, reference=Q1). There was no association between SVI and ophthalmic complications. Higher SVI is associated with disparities in receipt of cataract surgery among Medicare beneficiaries, which may be mediated by delays in cataract diagnosis. Reducing SDOH-related barriers to timely diagnosis in under-resourced areas could shorten the overall time to cataract surgery in this population.
K. C. Nguyen, Taylor Hall, Siqi Gan et al.· BMC Ophthalmology· 0 citations
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