D151. Socioeconomic Factors Associated With Delayed Presentation in Craniosynostosis Surgery at a Tertiary Children’s Hospital

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PURPOSE: This study investigates socioeconomic factors contributing to delayed craniosynostosis surgical consultation. METHODS: This retrospective cohort study included 696 California-based patients who underwent surgical intervention for craniosynostosis from 2006-2023 at a tertiary children's hospital. Patient zip codes were used to calculate state-specific Area Deprivation Index (ADI), measuring socioeconomic disadvantage. Distance from the hospital was calculated using the Haversine Formula. Multivariate linear and logistic regression was performed for age of consultation presentation and presenting after age four months based on age, race/ethnicity, insurance type, syndromic status, suture type, and zip code-based socioeconomic factors. RESULTS: Average age at first consultation was 5.7±4.7 months with 58.4% having public insurance and average distance to the hospital was 48.3km. Racial/ethnic breakdown was White (23.6%), Hispanic/Latinx (41.2%), Asian (3.7%), Black/African-American (2.0%), or Other/Unreported (29.5%). The mean ADI was 4.9±2.1 with an average median household income of 81,658±28,900. By linear regression, Black/African-American race (β=3.143, p=0.014), public insurance (β=1.172, p=0.002), and higher ADI (β=0.351, p=0.005) contributed to an older age of presentation. Patients with public insurance (Odds Ratio [OR] 1.903, p=0.002) and higher ADI decile (OR: 1.121, p=0.057) were more likely to present after four months of age. CONCLUSION: Patients who are Black/African American, have public insurance, or are from areas of more significant disadvantage presented later for initial surgical consultation. Initiatives should address these barriers to allow equitable access to all surgical options to improve patient outcomes.