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The Impact of Socioeconomic Status on Time to Decannulation Among Children With Tracheostomies
Matthew M Smith1,2, Catherine K Hart1,2, Dan T Benscoter3,4
1Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio, USA.
Insights
Children with lower socioeconomic status (SES) experienced a significantly longer time to tracheostomy decannulation, taking about 10 months longer. This highlights potential healthcare disparities in pediatric care.
Area of Science:
- Pediatric Medicine
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Tracheostomy decannulation is a critical milestone in pediatric care.
- Socioeconomic status (SES) may influence healthcare access and outcomes.
- Understanding disparities in decannulation time is essential for equitable care.
Purpose of the Study:
- To investigate if socioeconomic status impacts the time to tracheostomy decannulation in children.
- To identify potential healthcare disparities related to SES in pediatric tracheostomy care.
Main Methods:
- A retrospective case series with chart review was conducted at a tertiary pediatric medical center.
- Socioeconomic status (SES) was determined using US Census Bureau data and principal components analysis.
- Statistical analyses included chi-squared tests, Wilcoxon rank-sum tests, and a general linear model to control for clinical factors.
Main Results:
- A total of 215 pediatric patients (≤21 years) who underwent tracheostomy were analyzed.
- Children in the low-SES group experienced significantly longer decannulation times (38.7 months) compared to the high-SES group (28.0 months).
- The low-SES group took an average of 10 months longer to decannulate (P = .0007).
Conclusions:
- Healthcare disparities exist in the time to tracheostomy decannulation among children.
- Lower socioeconomic status is associated with a significantly longer duration to decannulation.
- Addressing SES-related factors may improve equitable outcomes for children requiring tracheostomy.
Objective:
To determine if time to tracheostomy decannulation differs among children by socioeconomic status.
Study Design:
Case series with chart review.
Setting:
Tertiary pediatric medical center.
Methods:
Patients (≤21 years old) who underwent tracheostomy from January 1, 2011, to December 31, 2016. Patients were divided into 2 groups based on their socioeconomic status (SES), low SES and high SES. Principal components analysis was used to create an index for SES using census data obtained by the US Census Bureau's American Community Survey 5 year data profile from 2013 to 2017. Statistical analysis was performed using a χ2 for categorical variables and Wilcoxon rank-sum test for continuous variables. A general linear model was constructed to control for clinical factors to understand the independent effect of SES on time to decannulation.
Results:
In total, 215 patients were included; of these patients, 111 patients (52%) were included in the high-SES group and 104 patients (48%) were included in the low-SES group. There was a significant difference in the time to decannulation for children based on SES status, with those children in the low-SES group taking on average 10 months longer to decannulate (38.7 vs 28.0 months, P = .0007). Median follow-up was 44.1 months (interquartile range, 29.6-61.3 months).
Conclusion:
Health care disparities appear to exist among children undergoing decannulation of their tracheostomy tube. Patients with lower SES had a significantly longer time to decannulation than those with higher SES.
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