Surgery for Otitis Media in a Universal Health Care Model: Socioeconomic Status and Race/Ethnicity Effects

Abstract

In a universal health care model serving more than 2 million children, previously reported proxies of low SES as well as minority race/ethnicity were not associated with surgically managed otitis media contrary to reported literature. Caucasian race, young age, and day care attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

“…TRICARE is a UHC in the United States with almost full governmental coverage for all active-duty and retired military service personnel as well as their dependents. Previous reports studying the population under TRICARE [25], [26] have shown that even in the United States with a wide range of SES, UHC with high publicly funded coverage offered equal access to high-tech care. We suppose that this policy of keeping out-of-pocket payments affordable for a patient's household plays an important role in a patient choosing advanced care, such as cardiovascular interventions.…”

Pediatric otolaryngologic conditions: Racial and socioeconomic disparities in the United States

“…Racioethnic disparities are controversial and complex, and may result from physician biases regarding clinical practice, patient biases in seeking health care, or actual inequalities of health care access. White children appear to undergo tympanostomy tube insertion at higher rates compared to black or Hispanic children, which may result from delayed access to surgical management for minority children . The senior authors previously reported a larger proportion of black and Hispanic children with FEI who were unable to afford prescription medications when indicated, compared to white children .…”

“…White children appear to undergo tympanostomy tube insertion at higher rates compared to black or Hispanic children, which may result from delayed access to surgical management for minority children. 15,25 The senior authors previously reported a larger proportion of black and Hispanic children with FEI who were unable to afford prescription medications when indicated, compared to white children. 17 Although the senior authors also previously found no race-based differences in antibiotic prescribing, 26 others have reported that black children received antibiotics at lower rates compared to nonblack children.…”

Innate Immunity: Orchestrating Inflammation and Resolution of Otitis Media

“…Currently, treatment for uncomplicated OM consists of watchful waiting or antibiotics [9, 10]. Tympanostomy tubes for middle ear (ME) ventilation are often recommended for recalcitrant cases [11–13]. The insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the USA, at 670,000 insertions annually costing over 4 billion dollars [14].…”

“…The causes of persistent ME infections and the reasons why some children progress to persistent/recurrent OM while others experience no or fewer OM episodes are not fully understood. Epidemiologic studies indicate that OM proneness in humans receives contributions from infection-related Eustachian tube dysfunction, immunologic naïveté, economic and health care status, plus prior exposure to upper respiratory viral infections [13, 17, 29]. However, it is also clear that genetics play a significant role, as indicated by twin studies [29–32].…”