Sociodemographic disparities and healthcare utilization in pediatric obstructive sleep apnea management.
Sociodemographic disparities and healthcare utilization in pediatric obstructive sleep apnea management.
复制标题
儿科阻塞性睡眠呼吸暂停管理中的社会人口差异和医疗保健利用。
DOI：
10.1016/j.sleep.2023.07.009
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发表时间：
2023
期刊：
影响因子：
4.8
通讯作者：
Williamson,ArielA
中科院分区：
文献类型：
--
作者：
Min,Jungwon;Zhang,Xuemei;Griffis,HeatherM;Cielo,ChristopherM;Tapia,IgnacioE;Williamson,ArielA
我们检查了(1)医疗补助参保儿童(MIC)中阻塞性睡眠呼吸暂停(OSA)护理的保险覆盖范围、儿童种族和民族的差异，以及(2)OSA护理后医疗利用的变化。方法使用IBM MarketScan保险索赔来索引2017年2-17岁儿童首次诊断OSA前后1年的OSA护理(n=0.31,787，MIC：59%)。根据儿童年龄、性别、肥胖和复杂的慢性疾病进行调整的OSA护理和医疗利用分析。结果我们确定了8种OSA护理途径，包括无护理，发生在总样本的34.4%。与商业保险儿童(CIC)相比，MIC没有OSA护理的几率高出13%。MIC在任何涉及专科护理的治疗途径中的几率较低32-48%，但在没有多导睡眠图(PSG)和仅接受PSG的情况下接受手术护理的可能性高13-46%。在MIC中，非拉丁裔黑人/非裔美国人(黑人)和西班牙裔/拉丁裔儿童接受特殊护理和/或PSG治疗的可能性是白人儿童的1.3-2.2倍，而黑人儿童接受手术的可能性比白人青年低31%。在全样本中，与未接受治疗或未接受手术治疗的患者相比，手术治疗与较少的门诊和急诊医疗保健利用有关。结论通过保险范围对OSA进行不同的管理，表明MIC在获得和参与护理方面存在差异，并可能增加疾病负担。外科护理与降低医疗保健利用率有关。应根据阻塞性睡眠呼吸暂停综合征的严重程度、医疗保健偏见和家庭偏好进一步评估Black MIC的手术几率较低。
ObjectivesWe examined (1) disparities in obstructive sleep apnea (OSA) care by insurance coverage, and by child race and ethnicity among Medicaid-insured children (MIC), and (2) healthcare utilization changes after OSA care.MethodsIBM MarketScan insurance claims were used to index OSA care 1-year before and after initial OSA diagnosis in 2017 among 2-17-year-old children (n = 31,787, MIC: 59%). OSA care and healthcare utilization analyses adjusted for child age, sex, obesity, and complex chronic conditions.ResultsWe identified 8 OSA care pathways, including no care, which occurred in 34.4% of the overall sample. MIC had 13% higher odds of no OSA care compared to commercially-insured children (CIC). MIC had 32–48% lower odds of any treatment pathway involving specialty care, but a 13–46% higher likelihood of receiving surgical care without polysomnogram (PSG) and PSG only. In MIC, non-Latinx Black/African American (Black) and Hispanic/Latinx children were 1.3–2.2 times more likely than White children to receive treatment involving specialty care and/or PSG, while Black children were 31% less likely than White youth to undergo surgery. In the full sample, surgical care was associated with less outpatient and emergency healthcare utilization compared to those untreated or not surgically treated.ConclusionsVaried OSA management by insurance coverage suggests disparities in access to and engagement in care and potentially greater disease burden among MIC. Surgical care is associated with reduced healthcare utilization. The lower odds of surgery in Black MIC should be further evaluated in the context of OSA severity, healthcare biases, and family preferences.