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Geographic and racial/ethnic patterns of polysomnography use among children enrolled in Medicaid, 2017-2019
Colleen C McLaughlin1, Jesse L Hawke2, Emily F Boss3
1Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA. colleen.mclaughlin@nationwidechildrens.org.
Insights
Pediatric polysomnography (PSG) use varied significantly across the US, with higher rates in metropolitan areas and among White populations. These findings highlight disparities in sleep study access for children in Medicaid.
Area of Science:
- Pediatric Sleep Medicine
- Health Services Research
- Geographic Health Disparities
Background:
- Polysomnography (PSG) is crucial for diagnosing pediatric sleep disorders like obstructive sleep apnea.
- Understanding geographic utilization patterns of pediatric PSG is essential for addressing access disparities.
Purpose of the Study:
- To describe the geographic distribution of pediatric polysomnography (PSG) utilization among children enrolled in Medicaid.
- To identify factors associated with variations in PSG access.
Main Methods:
- Cross-sectional observational study using Transformed Medicaid Information System (T-MSIS) research analytic files (2017-2019).
- Calculated age-adjusted PSG rates per 10,000 children at national, state, and local levels.
- Modeled PSG rates by Rural-Urban Commuting Area (RUCA) and race-ethnicity at ZIP code level.
Main Results:
- A national rate of 50.1 PSGs per 10,000 children was observed.
- State-level rates showed a fourfold difference, from 23 (Kansas) to 93 (Michigan) per 10,000.
- Higher PSG utilization was found in ZIP codes with >90% White population and in metropolitan areas.
Conclusions:
- Significant geographic disparities exist in pediatric PSG utilization within the US Medicaid population.
- Findings can inform efforts to improve equitable access to diagnostic sleep studies for children.
- Data can guide the refinement of practice guidelines and healthcare policy for pediatric sleep care.
Purpose:
The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019.
Methods:
The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Bureau Division, state and local levels. Geographic patterns were visualized with maps and plots. PSG rates were modeled by Rural-Urban Commuting Area (RUCA) classification and race-ethnicity composition at the ZIP code level. Data quality concerns resulted in exclusion of Rhode Island and Vermont.
Results:
There were 478,568 PSGs identified among eligible children in the claims data, resulting in a national rate of 50.1 PSGs per 10,000 Medicaid enrolled children per year. There was a fourfold difference in rates at the state level, ranging from 23 PSGs per 10,000 person-years (Kansas) to 93 per 10,000 (Michigan). New England and the Great Lakes regions had the highest local levels, while the Pacific and West South Central divisions had the lowest. ZIP codes with higher percent White population (> 90%) and those in metropolitan areas had the highest PSG rates.
Conclusion:
This descriptive study of pediatric PSG utilization in the USA can inform efforts to provide more equitable access to PSG and refinement of practice guidelines for referral to PSG.
Current Knowledge/Study Rationale:
Polysomnography provides a definitive diagnosis for obstructive sleep apnea and other sleep problems. Although there are concerns about variation in access, the utilization patterns of pediatric polysomnography in the USA is unknown.
Study Impact:
At the state level, polysomnography among children enrolled in Medicaid exhibited a fourfold difference in rates. ZIP codes in metropolitan areas and those with a high proportion of White non-Hispanic population had the highest utilization rates. These data can inform consensus among professional groups and healthcare policy researchers to improve equitable utilization.
