Sociodemographic Disparities in Craniosynostosis: A Systematic Review

Citation:Blum JD, Ng JJ, Craig J, Smith R, Kota A, Moura SP, Ford AD, Kalluri MH, Garland C, Cho DY. Sociodemographic Disparities in Craniosynostosis: A Systematic Review. Cleft Palate Craniofac J. 2025 Jan;62(1):87-96. doi: 10.1177/10556656231199832. Epub 2023 Sep 10. PMID: 37691284.

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Background

Craniosynostosis happens when a baby’s skull bones join together too early, preventing the brain from growing normally and causing an unusual head shape. It affects 3 to 8 out of every 10,000 babies and is twice as common in boys. The most common type is sagittal synostosis, which makes the head look long and narrow.

Treatment requires surgery to open the fused bones. Doctors use either open surgery (larger incision, longer recovery, often requires blood transfusions) or minimally invasive surgery (smaller incisions, faster recovery). However, minimally invasive surgery only works if the baby is diagnosed before 4 months old. Because timing is so important, delays based on race or insurance—called sociodemographic disparities—can prevent babies from getting the easiest treatment.

Methods

Researchers conducted a "systematic review" of 273 articles following PRISMA guidelines. They searched databases like PubMed and Embase for studies on craniosynostosis and health disparities. They selected 18 high-quality studies covering 31,256 U.S. patients. The researchers analyzed factors like race, ethnicity, and insurance (private vs. Medicaid) to see how they affected surgery age, surgery type, costs, and complications. They also used the Area Deprivation Index (ADI) to measure how neighborhood poverty impacts care.

Results

The study found clear differences in care based on race and insurance. White babies averaged surgery at 6 months, while Hispanic babies waited until 9 months and Black babies until 10 months.

Conclusion

The review concludes that U.S. craniosynostosis care is unfair. Race and insurance are major risk factors for receiving worse care. Delays caused by systemic barriers like lack of transportation or implicit bias create a "domino effect". Late diagnosis leads to more invasive surgery, which increases medical risks and financial burdens for the most vulnerable families. The healthcare system must change to ensure every baby gets a fair start.