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The Northeastern Society of Plastic Surgeons

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Socioeconomic Disparities in Deformational Plagiocephaly
Alexandra Junn, Jacob Dinis, Aaron Long, Sacha Hauc, Joseph Lopez, John Persing, Michael Alperovich
Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA.

BACKGROUND: Deformational plagiocephaly (DP) is the result of external compression of the skull, and moderate to severe cases refractory to behavioral modification or physical therapy may be treated with an orthotic helmet. Insurance providers vary in their coverage of orthotic helmets. This study is the first to investigate the socioeconomic disparities in orthotic helmet therapy for DP correction.
METHODS: Cranial Technologies is the largest provider of cranial helmets in Connecticut. demographic variables including gender, age at presentation, length of first helmet therapy, length of second therapy if applicable, address zipcode, and insurance carrier were collected for all patients who presented to CT from 2014 to 2020. Patients were classified as having received one helmet, having received two helmets, or never receiving a helmet after consultation. Delayed presentation was defined as presenting for consultation after 8 months of age. Univariable logistic regressions were used to identify differences in age at consultation, whether helmet therapy was pursued, and length of helmet treatment based on insurance payer and household income quartile.
RESULTS: Of the 5,620 patients who were identified, 3,557 (63.29%) were male, and the mean age at presentation was 5.572.25 months. 4,100 (72.95%) received helmet therapy, with 674 (11.99%) receiving a second helmet. Of those receiving helmet therapy, 1,536 (37.46%) had Medicaid, while 2,558 (62.39%) were commercially insured. Patients on Medicaid were 1.30 times more likely to have a delayed presentation (P=0.017), while patients from the lowest income quartile were 1.26 (P=0.041), 1.58 (P


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