Multi-institutional Assessment of Otitis Media Epidemiology Using Real-world Data

Abstract

ObjectivesTo determine rates and risk factors of pediatric otitis media (OM) using real-world electronic health record (PEDSnet) data from January 2009 through May 2021. Study designRetrospective cohort study. SettingSeven pediatric academic health systems that participate in PEDSnet. MethodsChildren <6 months-old at time of first outpatient, Emergency Department, or inpatient visit were included and followed longitudinally. A time-to-event analysis was performed using a Cox proportional hazards model to estimate hazard ratios for OM incidence based on sociodemographic factors and specific health conditions. ResultsThe PEDSnet cohort included 910,265 children, 54.3% male, mean age (months) 1.3 [standard deviation (SD) 1.6] and mean follow up (years) 4.3 (SD 3.2). By age 3 years, 39.6% of children had evidence of one OM episode. OM rates decreased following pneumococcal-13 vaccination (PCV-13) and the COVID-19 pandemic. Along with young age, non-Hispanic Black/African American or Hispanic race/ethnicity, public insurance, higher family income, and male sex had higher incidence rates. Health conditions that increased OM risk included cleft palate [adjusted hazard ratio (aHR) 4.0 [95% confidence interval (CI) 3.9–4.2], primary ciliary dyskinesia [aHR 2.5 (95% CI 1.8–3.5)], trisomy 21 [aHR 2.0 (95% CI 1.9–2.1)], atopic dermatitis [aHR 1.4 (95% CI 1.4–1.4)], and gastroesophageal reflux [aHR1.5 (95% CI 1.5–1.5)]. ConclusionsApproximately 20% of children by age 1 and 40% of children by age 3 years will have experienced an OM episode. OM rates decreased after PCV-13 and COVID-19. Children with abnormal ciliary function or craniofacial conditions, specifically cleft palate, carry the highest risk of OM.