Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing
OBJECTIVE: 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).
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary children's hospital.
METHODS: 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.
RESULTS: 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 (P < .001) and had a median driving distance of 74.8 vs 16.8 miles (P < .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).
CONCLUSION: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:166 |
|---|---|
| Enthalten in: |
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery - 166(2022), 6 vom: 18. Juni, Seite 1127-1133 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yan, Flora [VerfasserIn] |
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| Links: |
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| Themen: |
Health care disparity |
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| Anmerkungen: |
Date Completed 03.06.2022 Date Revised 02.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/0194599821993383 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM322060303 |
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| 500 | |a Date Revised 02.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: 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) | ||
| 520 | |a STUDY DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: Tertiary children's hospital | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 (P < .001) and had a median driving distance of 74.8 vs 16.8 miles (P < .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) | ||
| 520 | |a CONCLUSION: 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a health care disparity | |
| 650 | 4 | |a rurality | |
| 650 | 4 | |a sleep-disordered breathing | |
| 650 | 4 | |a tonsillectomy | |
| 650 | 4 | |a travel | |
| 700 | 1 | |a Levy, Dylan A |e verfasserin |4 aut | |
| 700 | 1 | |a Wen, Chun-Che |e verfasserin |4 aut | |
| 700 | 1 | |a Melvin, Cathy L |e verfasserin |4 aut | |
| 700 | 1 | |a Ford, Marvella E |e verfasserin |4 aut | |
| 700 | 1 | |a Nietert, Paul J |e verfasserin |4 aut | |
| 700 | 1 | |a Pecha, Phayvanh P |e verfasserin |4 aut | |
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