Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study

Abstract

ObjectivesAustralian Aboriginal children experience earlier, more frequent and more severe otitis media, particularly in remote communities, than non-Aboriginal children. Insertion of ventilation tubes is the main surgical procedure for otitis media. Our aim was to quantify inequalities in ventilation tube insertion (VTI) procedures between Australian Aboriginal and non-Aboriginal children, and to explore the influence of birth characteristics, socioeconomic background and geographical remoteness on this inequality.DesignRetrospective cohort study using linked hospital and mortality data from July 2000 to December 2008.Setting and participantsA whole-of-population cohort of 653 550 children (16 831 Aboriginal and 636 719 non-Aboriginal) born in a New South Wales hospital between 1 July 2000 and 31 December 2007 was included in the analysis.Outcome measureFirst VTI procedure.ResultsVTI rates were lower in Aboriginal compared with non-Aboriginal children (incidence rate (IR), 4.3/1000 person-years; 95% CI 3.8 to 4.8 vs IR 5.8/1000 person-years; 95% CI 5.7 to 5.8). Overall, Aboriginal children were 28% less likely than non-Aboriginal children to have ventilation tubes inserted (age-adjusted and sex-adjusted rate ratios (RRs) 0.72; 95% CI 0.64 to 0.80). After adjusting additionally for geographical remoteness, Aboriginal children were 19% less likely to have ventilation tubes inserted (age-adjusted and sex-adjusted RR 0.81; 95% CI 0.73 to 0.91). After adjusting separately for private patient/health insurance status and area socioeconomic status, there was no significant difference (age-adjusted and sex-adjusted RR 0.96; 95% CI 0.86 to 1.08 and RR 0.93; 95% CI 0.83 to 1.04, respectively). In the fully adjusted model, there were no significant differences in VTI rates between Aboriginal and non-Aboriginal children (RR 1.06; 95% CI 0.94 to 1.19).ConclusionsDespite a much higher prevalence of otitis media, Aboriginal children were less likely to receive VTI procedures than their non-Aboriginal counterparts; this inequality was largely explained by differences in socioeconomic status and geographical remoteness.

Australian Aboriginal children have higher hospitalization rates for otitis media but lower surgical procedures than non-Aboriginal children: A record linkage population-based cohort study

“…In our study, the most socio-economically advantaged children had the lowest OM hospitalization but the highest TTI rates. This is consistent with findings from a data linkage study conducted elsewhere in Australia [32], that reported similar TTI rates to ours and suggest that socioeconomic status and remoteness rather than Aboriginality explain the disparity [32]. Furthermore, 60% of TTIs in our study were performed in private metropolitan hospitals and, when combined with all metropolitan hospitals, 89% of all TTIs were done privately (S2 Table).…”

Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance

“…We found that children who were socially disadvantaged were less likely to receive medical treatments for otitis media. In addition, we found that children who were socially disadvantaged were less likely to receive tympanostomy tubes and more likely to be admitted for a severe otitis media complication, which is consistent with past work . In Australia, Aboriginal children from lower socioeconomic backgrounds had lower rates of receiving tympanostomy tubes than non–Aboriginal children but had 10-fold higher rates of hospitalization for otitis media .…”

“…In addition, we found that children who were socially disadvantaged were less likely to receive tympanostomy tubes and more likely to be admitted for a severe otitis media complication, which is consistent with past work. 11,14,31 In Australia, Aboriginal children from lower socioeconomic backgrounds had lower rates of receiving tympanostomy tubes than non-Aboriginal children but had 10-fold higher rates of hospitalization for otitis media. 11,31 In the US, Kogan et al 14 found that children without health insurance were less likely to receive tympanostomy tubes than those with insurance.…”

“…11,14,31 In Australia, Aboriginal children from lower socioeconomic backgrounds had lower rates of receiving tympanostomy tubes than non-Aboriginal children but had 10-fold higher rates of hospitalization for otitis media. 11,31 In the US, Kogan et al 14 found that children without health insurance were less likely to receive tympanostomy tubes than those with insurance. Beyond otitis media, increasing insurance coverage through the Patient Pro- tection and Affordable Care Act has been found to improve ambulatory pediatric health care access.…”

The O.P.E.N. Survey: outreach projects in Ear, Nose and Throat (ENT) in New South Wales

“…Despite experiencing a much higher prevalence of otitis media, Aboriginal children in NSW experience lower rates of surgical treatment for this condition compared with their non-Aboriginal peers. This is mainly due to "differences in socioeconomic status and geographical remoteness" with rates of surgery lowest among children living in a remote community (18). Improved outreach services to deliver consultations and operations is therefore one important way in which these unmet assessments and surgical problems could be addressed.…”