Abstract：
OBJECTIVE: Racial disparities are pervasive in access to pediatric surgery. The goal of this study was to test the hypotheses that, compared with White children, non-White and Hispanic children: (1) were less likely to attend evaluations by otolaryngologists after a diagnosis of otitis media (OM) eligible for surgical referral, and (2) these children were less likely to receive tympanostomy tube (TT) after surgical consultation.
METHODS: The OptumLabs Data Warehouse is a de-identified claims database of privately insured enrollees. Guidelines on the management of OMs suggest that children should be evaluated for surgery if they have recurrent acute OM or chronic OM with effusion. A cohort of children who were diagnosed with OM were constructed. For Hypothesis 1, the primary outcome was otolaryngology office visit within 6 months of a diagnosis of recurrent or chronic OM. For Hypothesis 2, the outcome was TT placement within 6 months following the otolaryngology office visit. Cox regression models were used to determine the relationship between race/ethnicity and the primary outcomes.
RESULTS: Among 187,776 children with OMs, 72,774 (38.8%) had otolaryngology visits. In a multivariate Cox model, the hazard ratios of attending otolaryngology visit for Black, Hispanic, and Asian children were 0.93 (95% CI,0.90, 0.96), 0.86 (0.83, 0.88), and 0.74 (0.71, 0.77), compared with White children. Among the children evaluated by otolaryngologists, 46,554 (63.97%) received TT. Black, Hispanic, and Asian children with recurrent acute OM had lower likelihood of receiving TT.
CONCLUSIONS: Racial disparities in attending otolaryngology office visit contributed to the disparities in receiving TT.
METHODS: Level 3 Laryngoscope, 134:3846-3852, 2024.
METHODS: The OptumLabs Data Warehouse is a de-identified claims database of privately insured enrollees. Guidelines on the management of OMs suggest that children should be evaluated for surgery if they have recurrent acute OM or chronic OM with effusion. A cohort of children who were diagnosed with OM were constructed. For Hypothesis 1, the primary outcome was otolaryngology office visit within 6 months of a diagnosis of recurrent or chronic OM. For Hypothesis 2, the outcome was TT placement within 6 months following the otolaryngology office visit. Cox regression models were used to determine the relationship between race/ethnicity and the primary outcomes.
RESULTS: Among 187,776 children with OMs, 72,774 (38.8%) had otolaryngology visits. In a multivariate Cox model, the hazard ratios of attending otolaryngology visit for Black, Hispanic, and Asian children were 0.93 (95% CI,0.90, 0.96), 0.86 (0.83, 0.88), and 0.74 (0.71, 0.77), compared with White children. Among the children evaluated by otolaryngologists, 46,554 (63.97%) received TT. Black, Hispanic, and Asian children with recurrent acute OM had lower likelihood of receiving TT.
CONCLUSIONS: Racial disparities in attending otolaryngology office visit contributed to the disparities in receiving TT.
METHODS: Level 3 Laryngoscope, 134:3846-3852, 2024.
摘要：
目的：种族差异在儿科手术中普遍存在。这项研究的目的是检验假设，与白人儿童相比，非白人和西班牙裔儿童：（1）在诊断为符合手术转诊条件的中耳炎（OM）后，不太可能参加耳鼻喉科医师的评估，（2）这些儿童在手术咨询后接受鼓膜置管（TT）的可能性较小。
方法：OptumLabsDataWarehouse是一个由私人投保人员组成的去识别索赔数据库。OMs管理指南建议，如果儿童复发性急性OM或慢性OM伴积液，应进行手术评估。构建了一组被诊断为OM的儿童。对于假设1，主要结果是诊断为复发性或慢性OM的6个月内的耳鼻喉科就诊。对于假设2，结果是耳鼻喉科就诊后6个月内的TT放置。Cox回归模型用于确定种族/民族与主要结局之间的关系。
结果：在187,776名患有OMs的儿童中，72,774（38.8％）进行了耳鼻咽喉科检查。在多元Cox模型中，布莱克耳鼻喉科就诊的危险比，西班牙裔,亚洲儿童为0.93（95%CI，0.90，0.96），0.86(0.83,0.88),和0.74（0.71，0.77），与白人儿童相比。在耳鼻喉科医生评估的儿童中，46,554（63.97%）收到TT。黑色,西班牙裔,亚洲儿童复发性急性OM接受TT的可能性较低。
结论：耳鼻喉科就诊的种族差异导致接受TT的差异。
方法：三级喉镜，2024.
方法：OptumLabsDataWarehouse是一个由私人投保人员组成的去识别索赔数据库。OMs管理指南建议，如果儿童复发性急性OM或慢性OM伴积液，应进行手术评估。构建了一组被诊断为OM的儿童。对于假设1，主要结果是诊断为复发性或慢性OM的6个月内的耳鼻喉科就诊。对于假设2，结果是耳鼻喉科就诊后6个月内的TT放置。Cox回归模型用于确定种族/民族与主要结局之间的关系。
结果：在187,776名患有OMs的儿童中，72,774（38.8％）进行了耳鼻咽喉科检查。在多元Cox模型中，布莱克耳鼻喉科就诊的危险比，西班牙裔,亚洲儿童为0.93（95%CI，0.90，0.96），0.86(0.83,0.88),和0.74（0.71，0.77），与白人儿童相比。在耳鼻喉科医生评估的儿童中，46,554（63.97%）收到TT。黑色,西班牙裔,亚洲儿童复发性急性OM接受TT的可能性较低。
结论：耳鼻喉科就诊的种族差异导致接受TT的差异。
方法：三级喉镜，2024.
