Does Socioeconomic Disadvantage Delay Access to Care for Craniosynostosis? A Study of 200 Children in Australia's Universal Healthcare Context

INTRODUCTION: Craniosynostosis, the premature fusion of calvarial bones, requires surgical intervention within a critical time-period. Early referral potentiates the application of less invasive treatments. Previous studies from the United States have demonstrated that socioeconomically disadvantaged groups experience delayed referrals, older age at surgery and require more complex interventions. This study investigated the relationship between socioeconomic status and management for non-syndromic single suture craniosynostosis within Australia's universal healthcare system. METHODS: A retrospective cohort study was completed at an Australian craniofacial centre from 2018 to 2024. Independent variables (Index of Relative Socioeconomic Advantage and Disadvantage score, rurality, sex, interpreter use) and outcomes (age at referral/surgery, time between referral and appointment, procedure type, complications, and length of stay) were analysed with univariate and multivariate models. RESULTS: Totally, 200 patients were included. Age at referral and surgery were negatively correlated with Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) percentile. Multiple linear regression models demonstrated that for each one-unit increase in the IRSAD decile, age at referral decreased by 24.26 days (p < 0.001) and age at surgery decreased by 23.29 days (p = 0.003). No other factors were found to affect age at referral or age at surgery, and there were no differences in type of surgery, complications or length of stay. DISCUSSION: This study found that patients from socioeconomically advantaged backgrounds were referred earlier and underwent surgery at a younger age compared to disadvantaged counterparts. However, patients underwent the same surgical procedures, indicating that in Australia's universal healthcare setting, patients are falling within the critical window for intervention regardless of socioeconomic status.