Racial/Ethnic and socioeconomic disparities in the prevalence and treatment of otitis media in children in the United States

Dl, Smith; Boss, Emily F.

doi:10.1002/lary.21090

Cited by 96 publications

(118 citation statements)

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“…For example, white children are more likely than black children to be referred to a subspecialist and to undergo placement of tympanostomy tubes. 6,[18][19][20] However, the role of tympanostomy tubes in the treatment of recurrent acute OM is debatable, 4 so it is unclear whether this translates into better care.…”

Section: Discussionmentioning

confidence: 99%

“…This study raises questions about whether physicians underdiagnose and undertreat OM among black children or overdiagnose and overtreat OM among nonblack children. Practice differences by race were apparent in previous studies from the 1990s and early 2000s, 2,6 but more recent studies have suggested that these practice differences may have attenuated. 2,[6][7][8][9] Our objectives were to determine whether national racial disparities currently exist in the diagnosis of OM or in the antibiotic choice for OM in children.…”

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confidence: 93%

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Race, Otitis Media, and Antibiotic Selection

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:A previous study suggested that physicians in 1 practice network were less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for OM for black versus nonblack children.WHAT THIS STUDY ADDS: Nationally, black children with OM are more likely to receive guideline-recommended, narrow-spectrum antibiotics than nonblack children. These findings may reflect inappropriate treatment of OM with the use of broad-spectrum antibiotics in a majority of US children. abstract BACKGROUND AND OBJECTIVE: Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally. METHODS:We examined OM visit rates during 2008 to 2010 for children #14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrowspectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM. RESULTS:The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).CONCLUSIONS: Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.

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Section: Discussionmentioning

confidence: 99%

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confidence: 93%

Race, Otitis Media, and Antibiotic Selection

et al. 2014

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“…Other relevant factors are season (greater AOM prevalence in autumn and winter) [Lubianca Neto et al, 2006], urbanisation (increased risk) [Paradise et al, 1997] and use of a pacifier (increased risk) [Uhari et al, 1996;Lubianca Neto et al, 2006]. The contribution of gastro-oesophageal reflux disease [Lubianca Neto et al, 2006] or socioeconomic deprivation [Smith and Boss, 2010] to risk is uncertain.…”

Section: The Exposomementioning

confidence: 99%

Epidemiology and Pathogenesis of Otitis Media: Construction of a Phenotype Landscape

Bhutta¹

2014

Audiol Neurotol

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Otitis media (OM) represents a complex set of clinically defined disease phenotypes. Epidemiological and pathological data suggest that inflammation of the middle ear occurs on a continuum of disease. Here I review epidemiological data and apply mathematical modelling to better define the interrelation of OM phenotypes, including the relationship of upper respiratory tract infection to acute OM (AOM), of AOM to OM with effusion, and of recurrent OM to chronicity of effusion. I use these mathematical models to represent OM graphically as a ‘landscape of disease'. This novel nosology may enable clinicians and researchers to better conceptualise middle ear inflammation in its various forms, although the limits of its application are also discussed.

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“…These differences could be due to ethnic variations in socio-economic factors (Vernacchio et al 2004) or in illness-seeking behavior (Park et al 2002), as well as genetics, but because many studies have been retrospective they have been unable to control for such confounders. Furthermore studies have been contradictory, and the conclusions of systematic (Smith & Boss 2010) relatively small total and demic population sizes, and each of these populations lived in relative geographic and social isolation. Hence, for the large part they were exposed only to local or regional microorganisms.…”

Section: Ethnic Variations In Otitis Media Incidencementioning

confidence: 99%

Evolution and Otitis Media: A Review, and a Model to Explain High Prevalence in Indigenous Populations

Bhutta¹

2015

Human Biology

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Inflammation of the middle ear (otitis media) comprises a group of disorders that are highly prevalent in childhood, and indeed are amongst the most common disorders of childhood. Otitis media is also heritable, and has effects on fecundity. This means that otitis media is subject to evolution, yet the evolutionary selection forces that may determine susceptibility to otitis media have never been adequately explored.Here I undertake a critical analysis of evolutionary forces that may determine susceptibility to middle ear inflammation. These forces include those determining function of the middle ear, those affecting host immunity, and those affecting colonization by, and pathogenicity of bacteria. I review existing mathematical evolutionary models of host-pathogen interaction and co-evolution, and apply these to develop a better understanding of the complex evolutionary landscape of middle ear infection and inflammation in humans. This includes an understanding of factors Pre--print version. Visit http://digitalcommons.wayne.edu/humbiol/ after 1 October 2015 to acquire the final version.2 determining the transition between stable evolutionary strategies for host and bacterial pathogens. This understanding will be later applied to analysis of otitis media in indigenous populations.In the second part of this article, I apply the approach of population genetics to devise a new theory for the high prevalence of otitis media in certain indigenous populations: the Australian Aborigine, the Native American, the Inuit, and the Maori.I suggest that high prevalence in such groups may have occurred as a result of colonization of these previously isolated populations by European immigrants in the 15 th and 16 th Centuries. This exposed them to new strains of bacteria to which their immune system had not evolved immunity, perturbing a previously stable hostpathogen co-evolutionary state.

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Racial/Ethnic and socioeconomic disparities in the prevalence and treatment of otitis media in children in the United States

Cited by 96 publications

References 39 publications

Race, Otitis Media, and Antibiotic Selection

Race, Otitis Media, and Antibiotic Selection

Epidemiology and Pathogenesis of Otitis Media: Construction of a Phenotype Landscape

Evolution and Otitis Media: A Review, and a Model to Explain High Prevalence in Indigenous Populations

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