Socioeconomic Inequities in the Surgical Management of Moyamoya Disease

Abstract

Given the vasculopathic nature of moyamoya disease (MMD) and high susceptibility to ischemic events, patients with MMD often require surgical revascularization via an indirect or direct bypass, and analysis of disparities in receipt of appropriate management is critical. The 2012-2016 Nationwide Inpatient Sample was queried for patients admitted with a diagnosis of MMD using International Classification of Diseases codes. Patient baseline demographics, hospital characteristics, and associated symptoms were collected. Patients were grouped by receipt of bypass procedure, and propensity score matching was performed to identify socioeconomic disparities between operative and nonoperative groups. Inclusion criteria were met by 4474 patients (827 pediatric patients and 3647 adult patients). Mean (SD) age for pediatric patients was 10.4 (4.6) years and for adult patients was 40.5 (14.4) years. Among pediatric patients, Black and Hispanic/Latino patients were less likely to undergo revascularization surgery (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.21-0.78, P ≤ 0.01; OR 0.47, 95% CI 0.26-0.84, P= < 0.01, respectively); among adult patients, Black and Hispanic/Latino patients were similarly less likely to undergo bypass procedures (OR 0.60, 95% CI 0.49-0.72, P ≤ 0.01; OR 0.73, 95% CI 0.55-0.96, P=0.01, respectively). Pediatric and adult patients in thelowest and next to lowest income quartiles were also less likely to receive operative treatment (pediatric patients: OR 0.61, 95% CI 0.40-0.94, P= 0.02; OR 0.64, 95% CI0.42-0.98, P=0.04, respectively; adult patients: OR 0.82, 95% CI 0.88-0.98, P= 0.03). Further investigation into socioeconomic disparities in adult and pediatric patients with MMD is warranted given the potential for inequities in access to appropriate intervention.