Persisting variance in middle ear ventilation tube insertion in Auckland children: why ethnic disparity continues

Insertion of ventilation tubes (VTs) is a common surgical treatment for recurrent and persistent otitis media, but surgical practice varies internationally. The current study explored variations in practice within New Zealand by examining VT insertion rates. The aim of the study was to determine time trends and current variations in VT insertion rates by ethnicity and district health board (DHB), with a focus on comparison of two DHBs in Auckland (Counties Manukau and Auckland DHB) to national average data.

Data for surgical procedures were analysed in the Atlas of Healthcare Variation domain, available via the Health Quality & Safety Commission website. Publicly funded events for New Zealand residents over a 10-year period (2009-2018) were examined for 0-4-year-olds. Individuals were assigned to their DHB of residence. VT rates for each DHB are presented per 1,000 population, with upper and lower confidence intervals calculated to the 95% level.

There was a general decline in the rates of VT insertions for the 0-4-year-olds over the 2009-2018 decade. Analysis of the 2018 year showed variation by ethnicity and DHB. In CMDHB, ADHB and nationally, Asian and Pacific ethnic groups had the lowest rates of VT insertions compared to other ethnic groups. In CMDHB, the VT rates for Māori, Pacific and Asian children were less than half that of their respective groups in ADHB. The NZ European/Other ethnic group had the highest rates of VT insertions in CMDHB and nationally, but in ADHB, the rate for the NZ European/Other group was similar to that for Māori.

These results are incongruent with evidence that Māori and Pacific children in New Zealand experience a greater burden of middle ear disease than NZ European children. The finding of persisting inequities in VT treatment for middle ear disease in 0-4-year-olds, with greatest impact on Pacific children, suggests that there may be a need for targeted middle ear screening for preschool children to detect pre-schoolers with ear disease, earlier than the 4-year-old B4 School Check.