Smith Matthew M, Hart Catherine K, Benscoter Dan T, Epperson Madison, de Alarcon Alessandro, Born Hayley, Meinzen-Derr Jareen
Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2021 Dec;165(6):876-880. doi: 10.1177/0194599820988501. Epub 2021 Feb 2.
To determine if time to tracheostomy decannulation differs among children by socioeconomic status.
Case series with chart review.
Tertiary pediatric medical center.
Patients (≤21 years old) who underwent tracheostomy from January 1, 2011, to December 31, 2016. Patients were divided into 2 groups based on their socioeconomic status (SES), low SES and high SES. Principal components analysis was used to create an index for SES using census data obtained by the US Census Bureau's American Community Survey 5 year data profile from 2013 to 2017. Statistical analysis was performed using a χ for categorical variables and Wilcoxon rank-sum test for continuous variables. A general linear model was constructed to control for clinical factors to understand the independent effect of SES on time to decannulation.
In total, 215 patients were included; of these patients, 111 patients (52%) were included in the high-SES group and 104 patients (48%) were included in the low-SES group. There was a significant difference in the time to decannulation for children based on SES status, with those children in the low-SES group taking on average 10 months longer to decannulate (38.7 vs 28.0 months, = .0007). Median follow-up was 44.1 months (interquartile range, 29.6-61.3 months).
Health care disparities appear to exist among children undergoing decannulation of their tracheostomy tube. Patients with lower SES had a significantly longer time to decannulation than those with higher SES.
确定不同社会经济地位的儿童在气管造口脱管时间上是否存在差异。
病例系列研究并进行图表回顾。
三级儿科医疗中心。
纳入2011年1月1日至2016年12月31日期间接受气管造口术的患者（年龄≤21岁）。根据社会经济地位（SES）将患者分为两组，即低SES组和高SES组。使用主成分分析法，利用美国人口普查局2013年至2017年美国社区调查5年数据概况获得的人口普查数据创建SES指数。对分类变量使用χ检验，对连续变量使用Wilcoxon秩和检验进行统计分析。构建一般线性模型以控制临床因素，以了解SES对脱管时间的独立影响。
共纳入215例患者；其中，111例患者（52%）纳入高SES组，104例患者（48%）纳入低SES组。根据SES状态，儿童脱管时间存在显著差异，低SES组儿童平均脱管时间长10个月（38.7个月对28.0个月，P = 0.0007）。中位随访时间为44.1个月（四分位间距，29.6 - 61.3个月）。
气管造口管脱管的儿童中似乎存在医疗保健差异。SES较低的患者脱管时间明显长于SES较高的患者。
