Predictors of Adenotonsillectomy for Publicly Insured Children With Sleep-Disordered Breathing.

Abstract

To examine sociodemographic factors (e.g., race, ethnicity, rural status) in adenotonsillectomy rates for pediatric obstructive sleep-disordered breathing with public insurance. This study included patients < 18 years with a diagnosis of obstructive sleep-disordered breathing with 12-month follow-up from 2011 to 2020 using the South Carolina Medicaid database. Logistic regression analyses were performed for adenotonsillectomy attainment within 1 year of diagnosis, with covariates of sex, age, race, ethnicity, geographic residence, and polysomnography. The cohort included 76,650 children (mean age [SD] 7.1 [4.5] years, 51.0% male). White children were more likely to undergo adenotonsillectomy than Black children (40%; relative risk [RR], 0.60; 95% CI, 0.57-0.62), Hispanic children (50%; RR, 0.50; 95% CI, 0.46-0.54), and other children (33%; RR, 0.67; 95% CI, 0.64-0.69). When polysomnography was obtained, these differences were no longer significant for Black (RR, 0.98; 95% CI, 0.89-1.06) and other (RR, 0.98; 95% CI, 0.89-1.06) children, and were reduced for Hispanic children (RR, 0.86; 95% CI, 0.72-1.00). When PSG was not used, children in large towns were more likely to undergo adenotonsillectomy than those in rural (RR, 0.69; 95% CI, 0.63-0.74) and urban cores (RR, 0.77; 95% CI, 0.74-0.80). This analysis of a statewide Medicaid database showed that Black and Hispanic children, as well as those living in urban and rural areas, were less likely to undergo adenotonsillectomy for sleep-disordered breathing than White children and those living in large towns. Associations were partially attenuated with preoperative polysomnography, suggesting a need to further understand its role in adenotonsillectomy disparities. Level 3.