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Sociodemographic Factors and Health Care Utilization in Pediatric Chronic Suppurative Otitis Media
William C Ruffin1, Jacob B Crouch2, Clayton P Burruss2
1Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A.
Insights
Children with chronic suppurative otitis media (CSOM) who have Medicaid insurance face challenges in accessing perioperative hearing care, particularly those in rural areas. This highlights a need for targeted interventions to improve healthcare utilization for this vulnerable pediatric population.
Area of Science:
- Otolaryngology
- Health Services Research
- Pediatric Healthcare
Background:
- Access to and utilization of perioperative healthcare are crucial for managing chronic suppurative otitis media (CSOM) in pediatric patients.
- Factors influencing healthcare utilization in this population remain poorly understood, necessitating further investigation.
Approach:
- A retrospective review was conducted on 427 pediatric CSOM patients (≤18 years) who underwent tympanoplasty with or without mastoidectomy between 2010 and 2020.
- Sociodemographic data and clinical information were collected, and univariate and multivariate logistic regression analyses were performed to identify associations with perioperative care utilization.
Key Points:
- Insurance status was the primary factor associated with healthcare utilization.
- Medicaid-insured children, especially those in rural areas, showed higher odds of pre- and post-operative no-shows and lower odds of receiving postoperative audiograms.
- Rural Appalachian children undergoing mastoidectomy had increased odds of cholesteatoma.
Conclusions:
- Pediatric CSOM patients with Medicaid insurance, particularly those in rural regions, exhibit reduced perioperative hearing healthcare utilization.
- These disparities can impact care delivery and clinical outcomes, underscoring the need for initiatives to enhance healthcare access and utilization in these underserved populations.
Objectives:
Access to and utilization of perioperative healthcare may influence outcomes in patients with chronic suppurative otitis media (CSOM); however, the influencing factors are poorly understood. The objective of this study was to assess the association of sociodemographic factors with perioperative health care utilization for pediatric CSOM patients.
Methods:
We conducted a review on pediatric CSOM patients (≤18 years old) who underwent tympanoplasty with/without mastoidectomy between 2010 and 2020. Sociodemographic data and clinical were collected on all participants. Univariate and multivariate logistic regression analysis was conducted to assess the association between these factors and perioperative care utilization.
Results:
427 patients were included in the study. The primary factor associated with health care utilization was insurance status. Rural children were more likely to have Medicaid insurance (p = 0.048). For tympanoplasty patients, Medicaid patients have 1.66 higher odds of pre-operative no-shows (p = 0.01), 1.31 higher odds of post-operative no-shows (p = 0.02), and 59% lower odds of having a postoperative audiogram (p = 0.01), and 2.64 higher odds of being from a rural community (p = 0.02). For patients undergoing mastoidectomy, Medicaid patients have 1.25 higher odds of postoperative no-shows (p = 0.01), 39% lower odds of having a revision procedure for ossicular reconstruction (p = 0.045). Appalachian rural mastoidectomy patients had 3.62 higher odds of having cholesteatoma (p = 0.05).
Conclusion:
Pediatric patients with CSOM who have Medicaid insurance, especially those who reside in rural regions, are at risk for lower perioperative hearing health care utilization. As these findings may impact care delivery and clinical outcomes, efforts should be focused on promoting utilization among these populations.
Level Of Evidence:
4 Laryngoscope, 133:700-705, 2023.
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