Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
Department of Healthcare Leadership and Management, Medical University of South Carolina College of Health Professions, Charleston, SC.
J Pediatr. 2021 Jun;233:191-197.e2. doi: 10.1016/j.jpeds.2021.01.071. Epub 2021 Feb 4.
To examine racial differences in tonsillectomy with or without adenoidectomy (T&A) for sleep-disordered breathing (SDB) among Medicaid-insured children.
Retrospective analysis of the 2016 MarketScan Multistate Medicaid Database was performed for children ages 2 to <18 years with a diagnosis of SDB. Patients with medical complexity and infectious indications for surgery were excluded. Racial groups were categorized into non-Hispanic White, non-Hispanic Black, Hispanic, and other. Adjusted multivariate logistic regression was used to determine if race/ethnicity was a significant predictor of obtaining T&A, polysomnography, and time to intervention.
There were 83 613 patients with a diagnosis of SDB that met inclusion criteria, of which 49.2% were female with a mean age of 7.9 ± 3.8 years. The cohort consisted of White (49.2%), Black (30.0%), Hispanic (8.0%), and other (13.2%) groups. Overall, 15.4% underwent T&A. Black (82.2%) and Hispanic (82.3%) children had significantly higher rates of no intervention and White patients had the lowest rate of no intervention (76.9%; P < .0001) and the highest rate of T&A (18.7%; P < .0001). Mean time to surgery was shortest in White compared with Black children (P < .0001). Logistic regression adjusting for age and sex showed that Black children had 45% reduced odds of surgery (95% CI 0.53-0.58), Hispanic 38% (95% CI 0.58-0.68), and other 35% (95% CI 0.61-0.70) compared with White children with Medicaid insurance.
Racial and ethnic disparities exist in the utilization of T&A for children with SDB enrolled in Medicaid. Future studies that investigate possible sources for these differences and more equitable care are warranted.
研究在医疗补助保险覆盖的儿童中，因睡眠呼吸障碍（SDB）行扁桃体切除术联合或不联合腺样体切除术（T&A）的种族差异。
对 2016 年 MarketScan 多州医疗补助数据库进行回顾性分析，纳入年龄在 2 至<18 岁、患有 SDB 的患者。排除具有医疗复杂性和感染性手术指征的患者。将种族分为非西班牙裔白人、非西班牙裔黑人、西班牙裔和其他。采用多变量逻辑回归分析确定种族/民族是否是接受 T&A、多导睡眠图和干预时间的显著预测因素。
共纳入符合纳入标准的 83613 例 SDB 患者，其中 49.2%为女性，平均年龄为 7.9±3.8 岁。队列包括白人（49.2%）、黑人（30.0%）、西班牙裔（8.0%）和其他（13.2%）。总体而言，15.4%的患者接受了 T&A。黑人（82.2%）和西班牙裔（82.3%）患儿无干预的比例明显较高，而白人患者无干预的比例最低（76.9%；P<.0001），T&A 的比例最高（18.7%；P<.0001）。与黑人患儿相比，白人患儿手术时间最短（P<.0001）。调整年龄和性别后，接受多变量逻辑回归分析显示，黑人患儿手术的可能性降低了 45%（95%CI 0.53-0.58），西班牙裔患儿降低了 38%（95%CI 0.58-0.68），其他种族患儿降低了 35%（95%CI 0.61-0.70）。
在医疗补助保险覆盖的患有 SDB 的儿童中，T&A 的使用存在种族和民族差异。未来的研究需要调查这些差异的可能来源，并提供更公平的医疗服务。
