Mulry Erin, Grover Nancy
University of Connecticut School of Medicine, Department of Surgery, Division of Otolaryngology Head and Neck Surgery, 263 Farmington Avenue, Farmington, CT, 06030, USA.
Connecticut Children's, Department of Pediatric Otolaryngology, 282 Washington St Hartford, CT, 06106, USA.
Int J Pediatr Otorhinolaryngol. 2024 Jul;182:112002. doi: 10.1016/j.ijporl.2024.112002. Epub 2024 Jun 3.
COVID-19 has disproportionately affected healthcare access of certain minority groups, and thus could contribute to delay in timely evaluation and management of pediatric obstructive sleep apnea (OSA). Socioeconomic status (SES) is known to affect healthcare access in pediatric otolaryngology and may also be a risk factor for OSA and its associated co-morbidities.
Our primary objective is to determine the impact of COVID-19 on time to diagnosis (TTD) and time to treatment (TTT) of polysomnography (PSG)-proven moderate to severe pediatric OSA in different socioeconomic classes. Secondary objectives include determining the impact of racial and demographic factors on TTD and TTT.
This is a retrospective chart review of 120 children; 60 children pre-COVID (February 2018 to February 2020), and 60 children post-COVID onset (March 2020 to March 2022). This study was performed at a pediatric teaching hospital and tertiary referral center, and involved children aged 3-17 years old with outpatient PSG-proven moderate to severe OSA. Approval was obtained from our hospital's institutional review board (IRB).
There were a total of 120 children, 60 in each group. The average age was 9.5 years old; females constituted 41.6 % of the sample. TTD increased from 53.7 days pre-covid to 103 days post-COVID onset in all children (p = 0.00), 42.5 days-151.9 days in white children (p = 0.00), 38 days-142.7 days in children with high SES (p = 0.00), 32.1 days-146.5 days in children with private insurance (p = 0.00), and 65.7 days-105.8 days in children with public insurance (p = 0.04). TTT did not change significantly.
Our results show that TTD of OSA and obesity in advantaged groups were affected to a greater degree than disadvantaged groups. This suggests children of all socioeconomic groups are susceptible to healthcare disparities and the COVID-19 pandemic has uncovered the vulnerability of such populations. Policymakers should consider providing more funding and support for all children, including continued funding for those with lower SES.
新冠病毒病（COVID-19）对某些少数群体的医疗服务可及性产生了不成比例的影响，因此可能导致小儿阻塞性睡眠呼吸暂停（OSA）的及时评估和管理延迟。已知社会经济地位（SES）会影响小儿耳鼻喉科的医疗服务可及性，并且可能也是OSA及其相关合并症的一个风险因素。
我们的主要目的是确定COVID-19对不同社会经济阶层中多导睡眠图（PSG）证实的中度至重度小儿OSA的诊断时间（TTD）和治疗时间（TTT）的影响。次要目的包括确定种族和人口统计学因素对TTD和TTT的影响。
这是一项对120名儿童的回顾性病历审查；60名儿童在COVID-19之前（2018年2月至2020年2月），60名儿童在COVID-19发病后（2020年3月至2022年3月）。本研究在一家儿科教学医院和三级转诊中心进行，纳入了年龄在3至17岁、门诊PSG证实为中度至重度OSA的儿童。获得了我们医院机构审查委员会（IRB）的批准。
共有120名儿童，每组60名。平均年龄为9.5岁；女性占样本的41.6%。所有儿童的TTD从COVID-19之前的53.7天增加到发病后的103天（p = 0.00），白人儿童从42.5天增加到151.9天（p = 0.00），高SES儿童从38天增加到142.7天（p = 0.00），有私人保险的儿童从32.1天增加到146.5天（p = 0.00），有公共保险的儿童从65.7天增加到105.8天（p = 0.04）。TTT没有显著变化。
我们的结果表明，优势群体中OSA和肥胖的TTD比弱势群体受到的影响更大。这表明所有社会经济群体的儿童都易受医疗保健差距的影响，并且COVID-19大流行揭示了这些人群的脆弱性。政策制定者应考虑为所有儿童提供更多资金和支持，包括继续为SES较低的儿童提供资金。
