Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2022 Jun;166(6):1127-1133. doi: 10.1177/0194599821993383. Epub 2021 Mar 2.
To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA).
Retrospective cohort study.
Tertiary children's hospital.
A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses.
In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( < .001) and had a median driving distance of 74.8 vs 16.8 miles ( < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99).
Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.
评估城乡居住环境对接受扁桃体切除术联合或不联合腺样体切除术（TA）治疗阻塞性睡眠呼吸障碍（SDB）儿童的影响。
回顾性队列研究。
三级儿童医院。
本研究纳入了 2016 年 4 月至 2018 年 12 月期间被诊断为阻塞性 SDB 且推荐接受 TA 的年龄在 2 至 18 岁的其他健康儿童。城乡划分通过邮政编码接近城乡通勤区代码来定义。主要结局指标是使用 Cox 和 logistic 回归分析评估城乡差异与 TA 时间和失访的关系。
共纳入 213 例患者（平均年龄 6 ± 2.9 岁，117 例[55%]为男性，69 例[32%]为农村居住）。与城市居住的患者相比，农村居住的患儿更常通过医疗补助而非私人保险（ <.001）投保，且中位驾车距离为 74.8 英里，而城市居住的患者为 16.8 英里（ <.001）。大多数（94.9%）患者最终在接受耳鼻喉科医生评估后接受了推荐的 TA。多变量逻辑回归分析并未发现任何导致接受 TA 随访失败的显著预测因素。调整年龄、性别、保险和种族的 Cox 回归分析显示，与城市居住的患者相比，农村居住的患者接受 TA 的时间延迟了 30%（风险比，0.7；95%CI，0.50-0.99）。
农村居住的患者接受 TA 的等待时间和驾车距离更长。本研究表明，城乡差异是手术干预的潜在障碍，并强调需要进一步研究地理可达性作为儿科 SDB 护理的重要决定因素。
