Economics Impact Pediatric Sleep-Disordered Breathing Care
(HealthDay News) — Children newly evaluated for sleep-disordered breathing (SDB) with public insurance experience longer intervals from initial evaluation to polysomnography or adenotonsillectomy, according to a study published online December 11 in JAMA Otolaryngology-Head & Neck Surgery.
Emily F. Boss, MD, MPH, from the Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a retrospective cohort study to examine the impact of socioeconomic status (SES) on the timing of polysomnography among patients newly evaluated for SDB. The authors used public insurance (Medical Assistance [MA]) as a proxy for low SES. Over the course of three months, 136 children without polysomnography were evaluated for SDB, of whom 45.6% had MA.
The researchers found that polysomnography was recommended for 49 and 50% of children with MA and private insurance, respectively (P>0.99). Forty-four percent of children were lost to follow-up after the initial visit. Compared with privately insured children, children with MA who obtained polysomnography had longer intervals between the initial encounter and polysomnography (mean interval, 141.1 vs. 49.9 days; P=0.001). For those children who underwent adenotonsillectomy after polysomnography, the mean time to adenotonsillectomy was 222.3 days for children with MA vs. 95.2 days for children with private insurance (P=0.001).
"This study emphasizes the need to understand factors contributing to disparities surrounding delay in care with polysomnography and surgery for children with SDB," the authors write.