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Differences in Tonsillectomy Utilization by Race/Ethnicity, Type of Health Insurance, and Rurality
Jennifer N Cooper1, Swapna Koppera2, Emily F Boss3
1Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital (JN Cooper and S Koppera), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (JN Cooper), Columbus, Ohio; Division of Epidemiology, The Ohio State University College of Public Health (JN Cooper), Columbus, Ohio.
Insights
Pediatric tonsillectomy rates are higher in white children, those with public insurance, and those in nonmetropolitan areas. These disparities highlight the need to investigate factors influencing tonsillectomy use for improved equity.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Health Disparities
Background:
- Tonsillectomy is a common pediatric surgical procedure with documented geographic and racial disparities.
- Previous studies indicated variations in tonsillectomy use, prompting further investigation into current utilization patterns.
Purpose of the Study:
- To compare contemporary pediatric tonsillectomy utilization rates in the United States.
- To analyze disparities based on child race/ethnicity, health insurance type, and geographic residence (metropolitan vs. nonmetropolitan).
Main Methods:
- Cross-sectional study utilizing healthcare databases from 8 US states (2013-2017).
- Included children under 15 years undergoing tonsillectomy.
- Calculated population-level rates and used negative binomial regression to compare sociodemographic groups.
Main Results:
- Tonsillectomy utilization was significantly higher in non-Hispanic white children compared to non-Hispanic black or Hispanic children.
- Publicly insured children and those residing in nonmetropolitan areas showed higher tonsillectomy rates.
- Utilization was highest among white children from nonmetropolitan areas, across all indications.
Conclusions:
- Pediatric tonsillectomy use in the US is disproportionately higher among white, publicly insured, and nonmetropolitan residing children.
- Further research is needed to identify multilevel factors contributing to these utilization differences.
- Addressing these disparities is crucial for improving the appropriateness and equity of pediatric tonsillectomy.
Objective:
Tonsillectomy is one of the most common pediatric surgical procedures. In previous decades, large geographic variation and racial disparities in its use have been reported. We aimed to compare contemporary rates of pediatric tonsillectomy utilization in the United States by child race/ethnicity, type of health insurance, and metropolitan/nonmetropolitan residence.
Methods:
We performed a cross-sectional study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Ambulatory Surgery and Services Databases and State Inpatient Databases of 8 US states. We included all children aged <15 years who underwent tonsillectomy in 2013 to 2017. Annual population-level tonsillectomy rates across states and sociodemographic groups overall and by surgical indication were calculated using US Census data. Negative binomial regression models were used to compare rates between groups.
Results:
In all states evaluated, tonsillectomy utilization was higher in non-Hispanic white children than non-Hispanic black or Hispanic children, higher in publicly insured than privately insured children, and higher in children residing in nonmetropolitan areas as compared to metropolitan areas (all P < .05). Tonsillectomy use was highest among white children from nonmetropolitan areas, both overall and for each indication (all P < .05).
Conclusions:
Tonsillectomy utilization is higher in US children who are white, publicly insured, and who live in nonmetropolitan areas. Future research should identify multilevel factors, such as those at the patient, family, primary care provider, otolaryngologist, health care delivery system, interpersonal and community levels, that explain these differences in utilization in order to improve the appropriateness and equity of tonsillectomy use in children.
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