Racial and Ethnic Disparities in Otolaryngology Office Visit and Tympanostomy Tube Placement in Children with Otitis Media

• Published in: The Laryngoscope Vol. 134; no. 8; pp. 3846 - 3852
• Main Authors: Shi, Yu, Heien, Herbert C., Orvidas, Laura J., Sangaralingham, Lindsey R., Halbauer, Moira, Warner, David O., Phelan, Sean
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-08-2024; Wiley Subscription Services, Inc
• Subjects: children; disparity; Ear diseases; ethnicity; Hypotheses; Inequality; otitis media; Otolaryngology; race; Racial differences; tympanostomy tube; ethnicity; race; tympanostomy tube; children; disparity; otitis media
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.31380

Objectives
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.
Quality of Evidence
Level 3 Laryngoscope, 134:3846–3852, 2024