Utilization of the Child Opportunity Index to Evaluate Timing of Tympanostomy Tube Placement

Socioeconomic factors including social determinants of health (SDOH) have been implicated in tympanostomy tube (TT) placement and otorrhea. The objective of this study was to determine whether SDOH play a role in delays from presentation to TT placement.

Retrospective cohort study.

Tertiary Care Center.

A retrospective chart review of patients 0 to 4 years old with first-time TT placement between January 1, 2023, and July 1, 2023, measured SDOH using nationally averaged Child Opportunity Index (COI) 3.0 data at the census-tract level. COI quintiles were dichotomized into low SDOH (very low and low COI) and not low SDOH (moderate, high, and very high COI).

A total of 962 patients met the inclusion criteria. Patients with low SDOH were more likely to be non-Hispanic black than patients without low SDOH (18% vs 4.5%) and more likely to have Medicaid insurance (62% vs 32%). Children with low SDOH traveled further for surgery than children without low SDOH (40 miles vs 20 miles). Time from surgery order to surgery was longer in children with low SDOH than those without even when adjusted for race/ethnicity, insurance, and clinical features. Time from last ear infection to initial presentation was also longer for children with low SDOH than for others in our unadjusted analysis; however, those with low SDOH had a shorter time in our adjusted analysis.

Children with low SDOH traveled longer distances for care and experienced significant delays to surgery. These findings support future research on transportation access and other financial interventions for these at-risk children.