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

Abstract

Importance: It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear.

Objective: To describe and quantify social disparities in the treatment patterns of otitis media in children in the US.

Design, setting, and participants: This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4 831 408 children with otitis media.

Exposures: Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score.

Main outcomes and measures: Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes.

Results: Among 4 831 408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994 921 (20.59%) were treated for recurrent otitis media, 717 978 (14.86%) were treated for suppurative otitis media, 335 949 (6.95%) received tympanostomy tubes, and 10 975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37).

Conclusions and relevance: The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.

Figure 1.. Geographic Distribution of Cohort by County

Population categories represent the 5th, 25th, 50th, 75th, and 95th percentiles with regard to number of children with otitis media within the cohort by county.

Figure 2.. Distribution of Social Deprivation Index and Social Vulnerability Index Scores Across the Cohort

The kite diagram shows the frequency of Social Deprivation Index (SDI) and Social Vulnerability Index (SVI) scores along respective indices, with the width of each kite representing relative frequency within each index. For each index, 0 represents the children who were the most socially advantaged, and 1.0 represents the children who were the most socially disadvantaged.