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Racial and Ethnic Disparities in Utilization of Tonsillectomy among Medicaid-Insured Children

Phayvanh P Pecha1, Marshall Chew2, Anne L Andrews3

  • 1Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.

The Journal of Pediatrics
|February 6, 2021
PubMed

Insights

Racial disparities in tonsillectomy with or without adenoidectomy (T&A) for sleep-disordered breathing (SDB) are evident among Medicaid-insured children. Black and Hispanic children were less likely to receive T&A surgery compared to White children.

Area of Science:

  • Pediatric Otolaryngology
  • Health Services Research
  • Health Equity

Background:

  • Sleep-disordered breathing (SDB) significantly impacts children's health and development.
  • Tonsillectomy with or without adenoidectomy (T&A) is a common surgical intervention for pediatric SDB.
  • Understanding racial and ethnic disparities in surgical care is crucial for equitable healthcare delivery.

Purpose of the Study:

  • To investigate racial differences in the rates and timing of T&A for SDB among children insured by Medicaid.
  • To identify if race/ethnicity is a significant predictor for receiving T&A surgery or undergoing polysomnography.

Main Methods:

  • Retrospective analysis of the 2016 MarketScan Multistate Medicaid Database.
  • Inclusion of children aged 2 to <18 years diagnosed with SDB, excluding those with medical complexity or infectious surgical indications.
  • Categorization of racial groups into non-Hispanic White, non-Hispanic Black, Hispanic, and other, with adjusted multivariate logistic regression analysis.

Main Results:

  • The study analyzed 83,613 children with SDB; 15.4% underwent T&A.
  • Black (82.2%) and Hispanic (82.3%) children had higher rates of no intervention compared to White children (76.9%).
  • White children had the highest T&A rate (18.7%) and shortest time to surgery. Adjusted analysis revealed significantly reduced odds of surgery for Black (45%), Hispanic (38%), and other (35%) children compared to White children.

Conclusions:

  • Significant racial and ethnic disparities exist in T&A utilization for pediatric SDB among Medicaid-enrolled children.
  • Non-White children, specifically Black and Hispanic children, are less likely to undergo T&A surgery for SDB.
  • Further research is needed to explore the sources of these disparities and develop strategies for more equitable care.
Abstract

Keywords:
Medicaidethnicitypediatricpolysomnographyracesleep-disordered breathing

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