Pediatric Ear Infections: Racial Disparities in Health Care

Abstract

OBJECTIVE: Although low socioeconomic status(SES) has been associated with increased mortality in children with Cystic Fibrosis(CF), little is known regarding SES or pulmonary outcomes in children with CF and rhinosinusitis. Our objectives were to evaluate SES and long-term pulmonary function in children with CF and rhinosinusitis, and to assess the association of endoscopic sinus surgery (ESS) on these outcomes. METHOD: We conducted a retrospective cohort study of CF children ages 0-21 from an urban tertiary CF center, referred to Otolaryngology between 1998-2008. Children were analyzed based on SES [Medicaid (MA)] or surgery status (ESS). Pulmonary function tests (PFTs): FVC% predicted, FEV1% predicted] were recorded over time. Mean comparison and multivariate regression analyses were performed to compare groups and test the association of ESS or MA on long-term PFTs. RESULTS: Of 59 patients evaluated, 21 (36%) underwent ESS, and 16 (27%) had MA. Age at evaluation and gender were similar regardless of MA status or ESS. Polyps were more common in the ESS group (86% vs 34%, P0.001). At 2 years, improvement in FVC% predicted, but not FEV1% predicted, was associated with ESS (P0.056). Concerning SES, all baseline PFTs were lower for children with MA (P0.0001), however long-term changes were similar in socioeconomic groups. Multivariate analysis showed that children with MA were more likely to undergo ESS (P0.0001). Lower FEV1% predicted at 2-year follow-up was associated with MA status but not with ESS (P0.0001). CONCLUSION: ESS is not clearly associated with improved long-term pulmonary outcomes in children with CF and rhinosinusitis. Low SES, however, is associated with low baseline PFTs and may impact long-term outcomes in these children.