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[Preprint]. 2023 Sep 13:2023.09.12.23295450.
doi: 10.1101/2023.09.12.23295450.

Social Determinants of Genetics Referral and Completion Rates Among Child Neurology Patients

Jordan J Cole  1   2 , Angela D Sellitto  1 , Laura Rosa Baratta  3 , Julia B Huecker  4 , Joyce E Balls-Berry  1 , Christina A Gurnett  1
Affiliations

Social Determinants of Genetics Referral and Completion Rates Among Child Neurology Patients

Jordan J Cole et al. medRxiv. .

Update in

Abstract

Objective: To investigate clinical, social, and systems-level determinants predictive of genetics clinic referral and completion of genetics clinic visits among child neurology patients.

Methods: Electronic health record data were extracted from patients 0-18 years old who were evaluated in child neurology clinics at a single tertiary care institution between July 2018 to January 2020. Variables aligned with the Health Equity Implementation Framework. Referral and referral completion rates to genetics and cardiology clinics were compared among Black vs White patients using bivariate analysis. Demographic variables associated with genetics clinic referral and visit completion were identified using logistic regressions.

Results: In a cohort of 11,371 child neurology patients, 304 genetics clinic referrals and 82 cardiology clinic referrals were placed. In multivariate analysis of patients with Black or White ethnoracial identity (n=10,601), genetics clinic referral rates did not differ by race, but were significantly associated with younger age, rural address, neurodevelopmental disorder diagnosis, number of neurology clinic visits, and provider type. The only predictors of genetics clinic visit completion number of neurology clinic visits and race/ethnicity, with White patients being twice as likely as Black patients to complete the visit. Cardiology clinic referrals and visit completion did not differ by race/ethnicity.

Interpretation: Although race/ethnicity was not associated with differences in genetics clinic referral rates, White patients were twice as likely as Black patients to complete a genetics clinic visit after referral. Further work is needed to determine whether this is due to systemic/structural racism, differences in attitudes toward genetic testing, or other factors.

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Conflict of interest statement

Potential Conflicts of Interest The authors do not have any relevant conflicts of interest to disclose.

Figures

Figure 1 –
Figure 1 –. Alignment of Study Variables with the Health Equity Implementation Framework:
The independent variables included in this study of genetic service access were aligned across multiple levels of this simplified version of the Health Equity Implementation Framework. Deeper evaluation of provider and patient-level factors including motivation, genetic knowledge, and bias/discrimination is beyond the scope of this EHR study but planned for future mixed methods work.
Figure 2
Figure 2. Genetic Testing Workflow at Child Neurology Clinics:
Patients seen in child neurology clinics at WUSTL may have some genetic tests requested/ordered directly by their neurologist, such as chromosomal microarray (CMA), multigene panels (MGP), and fragile X testing. However, exome/genome sequencing (ES/GS), requires a referral to Genetics Clinic.
See this image and copyright information in PMC

References

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