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Epidemiology of Pediatric Surgery in the United States
Jennifer A Rabbitts1,2, Cornelius B Groenewald1,3
1Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Insights
Pediatric surgery rates in the US are stable, with 3.9 million procedures annually. However, Black and Hispanic children face significant disparities, experiencing lower surgical intervention rates.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Health Equity
Background:
- Epidemiology of pediatric surgery in the US is not well-understood.
- National-level disparities in access to pediatric surgical care require further investigation.
Purpose of the Study:
- To determine the rates of surgical intervention among children aged 0-17 in the United States.
- To examine associations between sociodemographic factors and pediatric surgical intervention rates.
Main Methods:
- Analysis of 155,064 children from the 2005-2018 National Health Interview Survey.
- Multivariate logistic regression models adjusted for multiple sociodemographic and clinical factors.
- Focus on recent data from 2016-2018 (25,544 children) for detailed analysis.
Main Results:
- Approximately 4.7% of children underwent surgery annually, averaging 3.9 million procedures nationwide.
- Rates remained stable from 2005 to 2018.
- Minority children (Black, Hispanic) had significantly lower adjusted odds of surgical intervention compared to White, non-Hispanic children.
Conclusions:
- Significant disparities in pediatric surgical care persist, particularly affecting minority children.
- Factors such as uninsured status and non-English primary language were associated with lower surgical intervention rates.
- National policies are needed to address and eliminate care disparities for minority children.
Background:
The epidemiology of pediatric surgery in the United States and whether disparities in access to surgical care exist on a national level remain inadequately described.
Aims:
We determined rates of surgical intervention and associations with sociodemographic factors among children 0-17 years of age in the United States.
Methods:
Analysis of the 2005-2018 National Health Interview Survey samples included 155,064 children. Parents reported on whether their child had a surgery or surgical procedure either as an inpatient or outpatient over the past 12 months. Multivariate logistic regression models, adjusted for age, sex, race and ethnicity, income, language, parent education, region, having a usual source of care, and comorbid conditions, examined odds ratios for sociodemographic factors associated with surgery, analyzing the most recent data (2016-2018; 25 544 children).
Results:
In the most recent data, 4.7% of children had surgical intervention each year, with an average of 3.9 million surgeries performed annually. Rates of surgery were stable between 2005 and 2018. Minority children had lower adjusted odds (aOR) of surgical intervention as compared to white, non-Hispanic children (aOR = 0.6, 95%CI = 0.5-0.8 for black children, and aOR = 0.7, 95%CI = 0.5-0.9 for Hispanic children). Other sociodemographic factors associated with a lower adjusted odd of surgical intervention included uninsured status (aOR = 0.5; 95%CI = 0.3-0.9), and primary language other than English (aOR = 0.5; 95%CI 0.3-0.9). Income was not associated with surgical intervention.
Conclusions:
On average, 3.9 million surgeries are performed on children 0-17 years of age in the United States each year. Significant disparities exist in surgical care for children, with black and Hispanic children having lower rates of surgery over and above contribution of other disparity domains. These findings in a nationally representative sample highlight the need for national policies to eliminate disparity of care received by minority children.
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