Race, Area Deprivation, and Patterns of Care in Pediatric Pilonidal Disease

Background Pilonidal abscess is common in adolescents and recurs frequently. Management requires wound care, follow-up, and access to surgical resources, all factors that are influenced by social determinants of health (SDOH). Whether neighborhood-level disadvantage, measured by the Area Deprivation Index (ADI), affects treatment location, follow-up, or recurrence in pediatric patients is unknown. Methods We retrospectively reviewed pediatric patients (<18 years) treated for pilonidal abscess during 2020-2024. Addresses were geocoded for 2020 ADI scores. Treatment was categorized as emergency department (ED) I&D, operating room (OR) I&D, or non-procedural. ADI was the primary exposure; race and ethnicity were secondary. Outcomes included treatment location, 30-day follow-up, and 6-month recurrence. Bivariate analyses and univariable logistic regression were performed. Results Among 133 encounters, mean age was 15.6 years and 68% were female. Median national ADI was 76 (IQR 48-89). ADI was not associated with treatment location, follow-up, or recurrence. Race was associated with 30-day follow-up ( P = 0.004); 59% of Black patients missed follow-up compared with 31% of non-Black patients. Ethnicity was associated with treatment location ( P = 0.015); Hispanic patients had lower odds of OR management (OR 0.38, 95% CI 0.15-0.91). Discussion In this predominantly high-disadvantage cohort, racial and ethnic disparities in pilonidal abscess management were identified despite no detectable ADI association. Persistence of patient-level disparities despite uniformly high ADI suggests that census-level metrics may lack the granularity to capture barriers relevant to acute pediatric surgical care. These preliminary observations, limited by narrow ADI dispersion, warrant prospective, multi-institutional confirmation with granular SDOH variables and multivariable modeling.