Facial Hemangiomas: Social and Demographic Barriers to Timely Care in a Large Population of Infants

Introduction: Early diagnosis and treatment of infantile hemangiomas (IH) has been shown to improve functional and aesthetic outcomes. The stakes are uniquely high in IH involving the face, where early intervention can halt the proliferative growth phase. We investigated the impact of socioeconomic and demographic factors on access to care for facial IH.

Methods: Clinical informatics techniques were utilized to identify patients diagnosed with facial IH at age <3 years at a single academic institution. The population was characterized by sex, race/ethnicity, preferred language, insurance payor, age at diagnosis, anatomic location, and treatment. Data were analyzed using multivariate logistic regression and chi squared analyses.

Results: A total of 267 infants (65.9% female) were included. The mean/median ages of diagnosis were 163 and 47 days, respectively. The population was 31.5% Caucasian, 21.7% Hispanic or Latino, 9.7% Asian, 3.6% Black, and 33.3% other ethnicities. Of the total, 42.3% were publicly insured and 13.8% were non-English speakers. Anatomically, IH were found in the following locations: cheek/forehead (45.7%), eyelid (34.8%), lips (16.9%), and nose (2.62%). For medication, 21.4% of patients received timolol, 19.5% of patients received propranolol, and 9.0% of patients received both.

Propranolol was initiated at significantly older mean ages in Asian (220 days) and Black/African American (226 days) ethnicity infants compared to Caucasian infants (72 days) (p = 0.001). Additionally, compared to patients with private insurance, publicly insured patients were prescribed timolol significantly later (422 days versus 52 days) (p = 0.001).

Conclusions: Delays in treatment for facial IH can result in more advanced, disfiguring lesions. Barriers to care were identified in publicly insured, Black and Asian patients. The age of propranolol initiation was over 3 times older in Black and Asian infants than Caucasian. Patients with public insurance waited over 8 times longer for timolol initiation than those with private. Further study is needed to better understand barriers and to improve care equity for this treatable condition.