Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
Sleep Med. 2023 Sep;109:211-218. doi: 10.1016/j.sleep.2023.07.009. Epub 2023 Jul 13.
We examined (1) disparities in obstructive sleep apnea (OSA) care by insurance coverage, and by child race and ethnicity among Medicaid-insured children (MIC), and (2) healthcare utilization changes after OSA care.
IBM MarketScan insurance claims were used to index OSA care 1-year before and after initial OSA diagnosis in 2017 among 2-17-year-old children (n = 31,787, MIC: 59%). OSA care and healthcare utilization analyses adjusted for child age, sex, obesity, and complex chronic conditions.
We identified 8 OSA care pathways, including no care, which occurred in 34.4% of the overall sample. MIC had 13% higher odds of no OSA care compared to commercially-insured children (CIC). MIC had 32-48% lower odds of any treatment pathway involving specialty care, but a 13-46% higher likelihood of receiving surgical care without polysomnogram (PSG) and PSG only. In MIC, non-Latinx Black/African American (Black) and Hispanic/Latinx children were 1.3-2.2 times more likely than White children to receive treatment involving specialty care and/or PSG, while Black children were 31% less likely than White youth to undergo surgery. In the full sample, surgical care was associated with less outpatient and emergency healthcare utilization compared to those untreated or not surgically treated.
Varied OSA management by insurance coverage suggests disparities in access to and engagement in care and potentially greater disease burden among MIC. Surgical care is associated with reduced healthcare utilization. The lower odds of surgery in Black MIC should be further evaluated in the context of OSA severity, healthcare biases, and family preferences.
我们考察了（1）在医疗补助保险覆盖范围内，以及在医疗补助保险覆盖的儿童（MIC）中按儿童种族和民族，阻塞性睡眠呼吸暂停（OSA）护理的差异；（2）OSA 护理后的医疗保健利用变化。
使用 IBM MarketScan 保险索赔来索引 2017 年 2-17 岁儿童（n=31787，MIC：59%）初始 OSA 诊断前 1 年和后 1 年的 OSA 护理。OSA 护理和医疗保健利用分析调整了儿童年龄、性别、肥胖和复杂的慢性疾病。
我们确定了 8 种 OSA 护理途径，其中包括在总体样本中占 34.4%的无护理途径。与商业保险儿童（CIC）相比，MIC 无 OSA 护理的可能性高 13%。MIC 接受任何涉及专科护理的治疗途径的可能性低 32%-48%，但接受无多导睡眠图（PSG）和仅 PSG 的手术治疗的可能性高 13%-46%。在 MIC 中，非拉丁裔黑人和非裔美国儿童（黑人）和西班牙裔/拉丁裔儿童比白人儿童接受涉及专科护理和/或 PSG 的治疗的可能性高 1.3-2.2 倍，而黑人儿童接受手术的可能性比白人儿童低 31%。在全样本中，与未经治疗或未经手术治疗的患者相比，手术治疗与较少的门诊和急诊医疗保健利用相关。
保险覆盖范围的 OSA 管理方式差异表明 MIC 在获得和参与护理方面存在差异，并且潜在的疾病负担更大。手术治疗与减少医疗保健利用有关。应在 OSA 严重程度、医疗保健偏见和家庭偏好的背景下，进一步评估黑人 MIC 中手术可能性较低的情况。
