Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
Boston University Medical Center, VA Boston Healthcare System, Boston, MA, USA.
Int J Pediatr Otorhinolaryngol. 2020 Sep;136:110181. doi: 10.1016/j.ijporl.2020.110181. Epub 2020 Jun 11.
Adenotonsillectomy (AT) is a common pediatric procedure performed for sleep disordered breathing (SDB) or chronic/recurrent tonsillitis. A better understanding of factors associated with clinical indications for AT would positively contribute to patient-centered care of these conditions. Our objective is to assess the relationships between race, ethnicity, and socioeconomic status (SES) and indications for adenotonsillectomy in pediatric patients.
A retrospective chart review was conducted for pediatric patients between the ages 0-18 years who underwent adenotonsillectomy between October 2012 and October 2017 at Boston Medical Center. Indication for surgery was categorized as sleep disordered breathing (SDB), tonsillitis, or other. Age, race, ethnicity, gender, language, distance to hospital and insurance type were collected as demographic variables. 9-Digit patient zip codes were matched to a corresponding area deprivation index (ADI) which combines 17 neighborhood level socioeconomic markers. Logistic regression analysis was performed to assess for association between demographic variables and indication for adenotonsillectomy.
1315 children were included in this study (mean age = 6.4 years, 0-18 years). African American (OR = 3.90, p-value <0.0001), Latino (OR = 2.602, p-value < 0.0001), and Asian American (OR = 4.439, p-value = 0.0146) patients were more likely to have SDB as an indication than Caucasian patients. Among children undergoing AT for SDB, patients who received pre-operative polysomnogram were more likely to be under 2 years old, African American, Asian American, or of Hispanic ethnicity and have higher BMI than patients who were diagnosed clinically prior to surgery. There was no statistically significant association between indications for adenotonsillectomy and ADI, distance to hospital, insurance status or language. Males were more likely have to have SDB as an indication than females (OR = 1.67, p-value = 0.0014). Younger patients under two years of age were more likely to have SDB as an indication for surgery when compared to older patients.
We found significant relationships between indications for adenotonsillectomy and race and ethnicity as well as gender and age. Additionally, our study showed that indication for AT was not associated with either ADI or insurance status. This suggests that race and ethnicity are predictors of indication independent of SES. Knowledge of predictive factors of adenotonsillectomy indications may help to improve patient centered care.
腺样体扁桃体切除术（AT）是一种常见的儿科手术，用于治疗睡眠呼吸障碍（SDB）或慢性/复发性扁桃体炎。更好地了解与 AT 临床适应证相关的因素将有助于以患者为中心治疗这些疾病。我们的目的是评估种族、族裔和社会经济地位（SES）与儿科患者腺样体切除术适应证之间的关系。
对 2012 年 10 月至 2017 年 10 月在波士顿医疗中心接受腺样体切除术的 0-18 岁儿科患者进行回顾性病历审查。手术适应证分为睡眠呼吸障碍（SDB）、扁桃体炎或其他。收集年龄、种族、族裔、性别、语言、到医院的距离和保险类型等作为人口统计学变量。9 位数字的患者邮政编码与相应的区域剥夺指数（ADI）相匹配，该指数结合了 17 个邻里水平的社会经济指标。采用逻辑回归分析评估人口统计学变量与腺样体切除术适应证之间的关系。
本研究共纳入 1315 名儿童（平均年龄 6.4 岁，0-18 岁）。非裔美国人（OR=3.90，p 值<0.0001）、拉丁裔（OR=2.602，p 值<0.0001）和亚裔美国人（OR=4.439，p 值=0.0146）患者比白人患者更有可能因 SDB 作为适应证。在因 SDB 接受 AT 的儿童中，接受术前多导睡眠图检查的患者更有可能年龄在 2 岁以下、非裔美国人、亚裔美国人或西班牙裔，并且 BMI 高于术前临床诊断的患者。腺样体切除术适应证与 ADI、到医院的距离、保险状况或语言之间没有统计学上的显著关联。男性比女性更有可能因 SDB 作为适应证（OR=1.67，p 值=0.0014）。与年龄较大的患者相比，2 岁以下的年轻患者更有可能因 SDB 作为手术适应证。
我们发现腺样体切除术适应证与种族、族裔以及性别和年龄之间存在显著关系。此外，我们的研究表明，AT 的适应证与 ADI 或保险状况无关。这表明种族和族裔是 SES 之外预测适应证的因素。了解腺样体切除术适应证的预测因素可能有助于改善以患者为中心的护理。
