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Socioeconomic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996-2000

Croxford R, Friedberg J, Coyte PC. Acta Paediatrica. 2004; 93(9):1245-50.

Aim — To examine the relation between socio-economic status and (1) receipt of paediatric otolaryngological surgery, and (2) inclusion of adjuvant procedures.

Methods — Using data on myringotomies with insertion of tympanostomy tube and tonsillectomies for all children in Ontario, Canada, from 1996 to 2000, and census data on socio-economic status, we examined the association between socio-economic status and (1) the probability of surgery (myringotomy or tonsillectomy), and (2) the probability that surgery was accompanied by an adjuvant procedure.

Results — Lower socio-economic status was associated with increased likelihood that a child's initial surgery was a tonsillectomy rather than a myringotomy (odds ratio per unit increase in the deprivation index = 1.09, p= 0.01, confidence interval 1.06–1.11), and with increased likelihood that those children having a myringotomy would undergo a tonsillectomy during the same hospitalization (odds ratio 1.14, p > 0.0001, confidence interval 1.11—1.16). Children from neighbourhoods with larger immigrant populations were less likely to receive either procedure (odds ratios per 1% increase in the proportion of immigrants = 0.97 (p > 0.0001, confidence interval 0.96–0.97) for myringotomies and 0.97 (p > 0.0001, confidence interval 0.97–0.98) for tonsillectomies).

Conclusions — Socio-economic status was associated with treatment selection for the two most common paediatric surgical procedures. Further research should examine whether differences in treatment arise at the level of the primary care physician, the specialist, and/or are due to parental preference.

Keywords: Social determinants of health Ear, nose and throat disorders Pediatric health