Does marginalization impact access to tympanostomy tube insertion in pediatric patients in Ontario?

Importance — Despite efforts to ensure equitable access to medically necessary services, disparities in care may persist in pediatric otolaryngology services.

Objective — To examine the relationship between socioeconomic marginalization and surgical wait times for tympanostomy tube insertion in the healthcare system of Ontario.

Study design — Population-based, retrospective cohort study utilizing administrative health data.

Setting — Ontario, Canada.

Participants — Patients ≤12 years who underwent bilateral tympanostomy tube insertion between 2010 and 2023 were included.

Exposures — Socioeconomic marginalization measured by the Ontario Marginalization Index, rurality and immigrant status.

Main outcome measures — ENT visit within 90 days of surgery, age at ENT visit, time from ENT visit to surgery, number of ENT visits during each year of follow-up, time to tympanostomy tube removal, and delayed tympanostomy tube removal (≥5 years post-surgery).

Results — A total of 76,574 tympanostomy tube patients were analyzed. As compared to the least marginalized patients, the most marginalized patients were significantly less likely to have an ENT visit within 90 days of surgery (75% vs 81.3%, P < .001). The number of emergency department visits (1: −15%, ≥2: −29%) was protective, decreasing age at ENT visit (P < .001). Furthermore, rural residence significantly increased the risk of higher age at ENT visit (+7%) (P < .001). Immigrant children were older at their final ENT visit and had longer surgical wait times compared to non-immigrant children (P < .001).

Conclusion — Significant disparities exist in accessing tympanostomy tubes; socioeconomic marginalization, prior emergency department visits, sex, immigrant and rural status delaying the age at final ENT visit before surgery.

Relevance — These findings underscore the need for targeted strategies to improve equitable access to pediatric ENT services.