Public Insurance and Timing of Polysomnography and Surgical Care for Children With Sleep-Disordered Breathing | Journal Scan
What is the impact of socioeconomic status on timing of adenotonsillectomy surgery in children at risk for sleep-disordered breathing?
This was a single-center, retrospective cohort analysis of children identified in the pediatric otolaryngology clinic for 3 months in 2011. Subjects were screened by evaluation codes for adenotonsillectomy (AT) or sleep-disordered breathing (SDB). Since medical insurance is a proxy for socioeconomic status (SES), subjects were grouped based on insurance. Time to an encounter with polysomnography (PSG) or surgery for AT was measured. Loss to follow-up was measured out to 1 year from encounter.
After excluding 35 children with a PSG prior to encounter, 136 met criteria, 62 with state Medical Assistance (MA) and 74 with private insurance. There was no difference in ages or gender among the two insurance groups. However, black children were more likely to have MA compared to white or other (Hispanic, Asian, or multiracial) children (p < 0.001). PSG was recommended in 40.4% and AT in 30.2% of children, with no difference noted between insurance groups (p = 0.53). Of the 96 children who were recommended to have either PSG or AT initially, 31 (32%) were lost to follow-up. For children with a PSG requested, 24 of 55 were lost to follow-up (44%) (9 of 24 in the MA group [33%] vs. 15 of 24 [54%] with private insurance; p = 0.13). Children who had PSG recommended were more likely to be lost to follow-up than children who had AT recommended, regardless of insurance (p = 0.003). For those children who underwent surgery (n = 51), time to AT was longer for children with MA (109.9 vs. 79.3 days, p = 0.23). For the children who underwent PSG (n = 27), those with MA had significantly longer time to PSG than privately insured individuals (141.1 vs 49.9 days; p = 0.001).
There are two key findings of this study. First, nearly half of the children recommended to have a PSG were lost to follow-up, regardless of insurance. Second, children from an otolaryngology clinic with SDB who have MA experienced longer wait times to undergo a PSG.
Higher rates of AT would be expected in children at risk for SDB; however, this trend was not observed. It is possible the children who were lost to follow-up had less severe disease. Future studies must assess patient and family social as well as economic issues to address barriers to scheduling a referral for treatment of SDB in children.
Keywords: Adenoidectomy, African Americans, Child, European Continental Ancestry Group, Hispanic Americans, Polysomnography, Sleep Apnea Syndromes, Social Class
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