Disparities in insurance status negatively affect patients with infantile hypertrophic pyloric stenosis
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In brief
In brief
This 10-year retrospective study examines how insurance type affects presentation timing and outcomes in infantile hypertrophic pyloric stenosis. After Medicaid Managed Care implementation, patients presented older with longer symptom duration but showed improved outpatient follow-up, suggesting enhanced healthcare access for publicly insured infants.
- Infants with IHPS presented older and with longer symptom duration after Medicaid Managed Care implementation (41.5 vs 36.5 days, p=0.022)
- Medicaid Managed Care improved outpatient follow-up rates within one month of hospitalization for IHPS patients
- Social determinants of health and insurance status significantly impact timing of presentation for infantile hypertrophic pyloric stenosis
- Despite delayed presentation in MMC era, length of hospital stay remained unchanged across insurance groups
Written by the GCMD Library team from the article.
Abstract
Purpose
Infantile hypertrophic pyloric stenosis (IHPS) is suspected to have worse outcomes when length of illness prior to presentation is prolonged. Our objective was to evaluate how social determinants of health influence medical care and outcomes for babies with IHPS.
Methods
A retrospective review was performed over 10 years. Census data were used as proxy for socioeconomic status via Geo-Identification codes and correlated with food access and social vulnerability variables. The cohort was subdivided to understand the impact of Medicaid Managed Care (MMC).
Results
The cohort (279 cases) was divided into two groups; early group from 2011 to 2015 and late from 2016 to 2021. Cases in the late group were older at the time of presentation (41.5 vs. 36.5 days; p = 0.022) and presented later in the disease course (12.8 vs. 8.9 days; p = 0.021). There was no difference in race (p = 0.282), gender (p = 0.874), or length of stay.
Conclusions
Patients who presented with IHPS after implementation of phased MMC were older, had a longer symptomatic course, and shorter pylorus measurements. Patients with public insurance after the implementation of MMC were more likely to follow-up with an outpatient pediatrician within a month of hospitalization. These results suggest that MMC may have improved access to care for infants with IHPS.