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Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era
Kara D Brodie1, Shayan Fakurnejad1, Josephine A Czechowicz1
1Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, USA.
Insights
During the COVID-19 pandemic, pediatric otolaryngology appointment attendance increased, but disparities in access persisted. Age, race, and insurance type, not telehealth, predicted attendance for children
Area of Science:
- Pediatric Otolaryngology
- Healthcare Access
- Public Health
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, particularly for specialized pediatric care.
- Limited data exists on how demographic factors and telehealth influenced access to pediatric otolaryngology services.
Purpose of the Study:
- To evaluate the effect of demographic factors and telehealth on attendance rates in pediatric otolaryngology during the COVID-19 pandemic.
- To identify predictors of appointment attendance in pediatric otolaryngology.
Main Methods:
- Retrospective observational study comparing referrals from March-December 2020 to March-December 2019.
- Analysis of patient demographics, referral-to-appointment duration, and appointment type.
- Multivariate linear regression to assess the impact of various factors on attendance.
Main Results:
- Appointment attendance was higher in 2020 (72%) compared to 2019 (62%).
- The time between referral and appointment decreased significantly in 2020 (10 days) versus 2019 (26 days).
- Black and Hispanic patients, older children, and publicly insured patients were less likely to attend appointments.
Conclusions:
- Demographic factors including age, race, and insurance type significantly predict access to pediatric otolaryngology care.
- Telehealth utilization did not predict appointment attendance.
- Findings highlight persistent healthcare access disparities in pediatric otolaryngology.
Objectives:
To assess the impact of demographic factors and telehealth on access to pediatric otolaryngology care during the COVID-19 pandemic, as measured by attendance.
Methods:
Retrospective, observational study of all referrals to pediatric otolaryngology at a single, tertiary care pediatric hospital system in the US. All referrals placed to pediatric otolaryngology from March through December 2020 were compared with referrals between March and December 2019. Data on patient demographics, date of referral, duration between referral and appointment, appointment type, and diagnosis acuity were collected. A multivariate linear regression was used to evaluate the impact of the patient age, ethnicity, language, insurance, diagnosis acuity, time to appointment, and appointment type on attendance.
Results:
This study included 1988 referrals placed between March 16th-December 31st, 2020 and 3704 referrals placed between March 16th-December 31st, 2019. In 2020, attendance proportions were significantly higher at 72% compared to 62% during 2019 (p < 0.001). In 2020, there was a significantly shorter duration between referral and appointment, averaging 10 days as compared to 26 days in 2019 (p < 0.001). Overall, Black and Hispanic patients, children over the age of one, publicly insured patients, and those with longer wait times were less likely to attend their appointments. Primary language and use of telehealth did not predict attendance.
Conclusion:
Early evidence has found significant healthcare access and outcome disparities across ethnicities during the COVID pandemic. However, there is limited data evaluating the effect of demographic factors or telehealth on access to pediatric otolaryngology care. This study identifies age, race and insurance type as predictors of access to pediatric otolaryngologic care, as measured by attendance.
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