Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?

Abstract

Introduction Despite recent concerns about potential overuse of tympanostomy tube (TT) placement to treat otitis media in children, utilization of this common procedure in the U.S. has been shown to be relatively less common among minority children. It is not known if the indications for TT differ by child race/ethnicity and/or socioeconomic status (SES). Our objective is to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for TT. Methods We conducted a retrospective chart review of children who underwent TT at single urban academic tertiary pediatric care center in a 6-month period (8/2013-3/2014). Children with congenital anomalies or syndromic diagnoses were excluded (50/137 children, 36.5%). Children were grouped by primary TT indication, recurrent acute otitis media (RAOM) or chronic otitis media with effusion (OME). Group characteristics were compared using t-tests and chi-square analyses, and logistic regression was performed to assess the association between demographics and TT indication. Results 87 children were included in this analysis (mean age=2.8 years,1-6 years). The most common indication for TT was RAOM (53%), and these children had a mean of 6 AOM episodes/year. Indications for TT varied significantly by the patient's neighborhood SES (median neighborhood income $70,969.09-RAOM vs $58, 844.95-OME, p-value=0.009) Those undergoing TT for RAOM were less likely to live in a high-poverty neighborhood (OR=0.36,p-value=0.02), whereas children who underwent TT for OME were more likely to live in a high-poverty neighborhood. There was no significant difference in indication by race/ethnicity or insurance type. Conclusions In this population, TT indications differed by SES. Among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of OME as opposed to RAOM. This finding suggests that concerns for appropriate use of TT in the setting of RAOM may be specific to a more affluent population. Future prospective patient-centered research will evaluate cultural and economic influences for families pursuing TT placement, as well as factors considered by physicians who make surgical recommendations.

Do demographic disparities exist in the diagnosis and surgical management of otitis media?

“…Whereas we found no disparity between demographic variables in the provision of MTs, a recently published report from Nieman et al indicated a differential of MT indication based on socioeconomic status. The authors demonstrated that children from high poverty areas were more likely than children from low poverty areas to receive MTs for OME, as opposed to recurrent acute otitis media.…”

“…These findings are similar to the findings from Shay et al, which showed that black and Hispanic children were less likely to be identified or diagnosed with frequent ear infections, hay fever, streptococcal pharyngitis, or sinusitis as compared to white children. 3 Whereas we found no disparity between demographic variables in the provision of MTs, a recently published report from Nieman et al 20 indicated a differential of MT indication based on socioeconomic status. The authors demonstrated that children from high poverty areas were more likely than children from low poverty areas to receive MTs for OME, as opposed to recurrent acute otitis media.…”

Healthcare disparities in pediatric otolaryngology: A systematic review

“…Children of lower SES experienced a wide range of disparities compared to higher SES peers, from higher rates of hearing loss to lower utilization of hearing rehabilitation to increased risk of post‐tonsillectomy complications (as summarized in Table ) . These are often independent of race and even insurance status . Myriad factors including income, education, and physical environment are associated with low SES.…”

Racial and Ethnic Differences in Receipt of Pressure Equalization Tubes Among US Children, 2014

“…Some emerging evidence suggests that, among children receiving PET placement, white children may be more likely to receive PET placement for RAOM, while black children were more likely to receive PET placement for COME. 30 However, until 2013, PET placement was not suggested in guidelines for the treatment of AOM prior to 2013. 4, 31 Most children who received PET placement in this study would have had placement prior to 2013.…”