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. 2025 Jul 10;17(5):100325.
doi: 10.1016/j.jham.2025.100325. eCollection 2025 Sep.

Analyzing socioeconomic characteristics in brachial plexus birth injuries: A multicenter public health analysis

Robbins Victoria  1 , Khabyeh-Hasbani Nathan  1 , O'Brien Devon  2 , Behbahani Mandana  3 , Meisel Erin  2 , Steven M Koehler  1
Affiliations

Analyzing socioeconomic characteristics in brachial plexus birth injuries: A multicenter public health analysis

Robbins Victoria et al. J Hand Microsurg. .

Abstract

Purpose: We aimed to examine and compare socioeconomic characteristics of infants with brachial plexus birth injury (BPBI) at two high-volume, distinct healthcare systems in the United States.

Methods: All patients diagnosed with non-transient BPBI presenting between November 2021-November 2023 at either institution, New York City ("NY") or Los Angeles ("LA"), were included. To stratify based on socioeconomic background, Area Deprivation Index (ADI) and Child Opportunity Index (COI) were utilized. ADIs were presented in national percentiles (1-100 %) or state-normed deciles (1-10), with higher rankings indicating greater disadvantage. COI scores and quintiles were assigned using nationally-normed ZIP code-level data, with lower COI signifying lower childhood opportunity. Continuous variables underwent two-tailed, unpaired Mann-Whitney U and t-tests. Categorical variables underwent chi-square tests. The significance level was set at p < 0.05.

Results: When comparing the LA (n = 92) and NY (n = 107) cohorts, the mean ADI scores were not significantly different: 24.5 % (SD 21.1) and 25.4 % (SD 13.5) respectively (p = 0.713). When comparing the COI scores, overall mean COI was significantly greater in LA (34.2, SD 26.9) compared to NY (17.3, SD 25.6; p < 0.001). While a significantly higher number of patients from NY than LA fell into categories of very low or low in education, social and economic, and overall COI, the distributions of these categories were more evenly spread across the LA cohort.

Conclusion: Our findings underscore the importance of considering regional differences in patient populations when patients present with BPBI, as addressing such disparities may increase equitable access to treatment and optimize functional outcomes. Given the time-sensitive nature of BPBI care and implications of long-term disability if left under-treated, it is essential to allocate resources towards effectively treating BPBI in affected demographics, especially those experiencing resource deficits. By acknowledging geographic-specific differences in resource access among BPBI populations, physicians can develop targeted strategies to ensure equitable BPBI care.

Keywords: Area deprivation index; Brachial plexus birth injury; Child opportunity index; Public health; Socioeconomic status.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Steven M. Koehler reports a relationship with American Society for Surgery of the Hand that includes: committee member. Erin Meisel reports a relationship with TISSIUM Inc that includes: consulting or advisory. Erin Meisel reports a relationship with Joint Development LLC that includes: equity or stocks. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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