Examining Associations Between Neighborhood-Level Social Vulnerability and Care for Children With Sleep-Disordered Breathing

Objective We aim to investigate the impact of neighborhood-level social vulnerability on otolaryngology care for children with obstructive sleep-disordered breathing (SDB). Study Design Retrospective cohort study. Setting A tertiary children’s hospital. Methods Children aged 2 to 17 years with SDB w...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2022-06, Vol.166 (6), p.1118-1126
Main Authors: Yan, Flora, Pearce, John L., Ford, Marvella E., Nietert, Paul J., Pecha, Phayvanh P.
Format: Article
Language:English
Subjects:
Child
Child, Preschool
disparity
Female
geocoding
geographic information systems
social vulnerability index
Humans
Male
obstructive sleep apnea
pediatric
Polysomnography
Retrospective Studies
Sleep Apnea Syndromes - surgery
sleep‐disordered breathing
Social Vulnerability
Tonsillectomy - methods
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Summary:Objective We aim to investigate the impact of neighborhood-level social vulnerability on otolaryngology care for children with obstructive sleep-disordered breathing (SDB). Study Design Retrospective cohort study. Setting A tertiary children’s hospital. Methods Children aged 2 to 17 years with SDB were included. Residential addresses were geocoded with geographic information systems, and spatial overlays were used to assign census tract–level social vulnerability index (SVI) scores to each participant. Multivariable logistic regression models were used to estimate associations of neighborhood SVI scores and individual factors with attendance of otolaryngology referral appointment and interventions. Results The study included 397 patients (mean ± SD age, 5.9 ± 3.7 years; 51% male, n = 203). After adjustment for age and sex, children with higher overall SVI scores (odds ratio [OR], 0.40; 95% CI, 0.16-0.92) and higher socioeconomic vulnerability scores (OR, 0.34; 95% CI, 0.14-0.86) were less likely to attend their referral appointments. The odds of attending referrals were 83% lower (OR, 0.17; 95% CI, 0.09-0.34) for Black children and 73% lower (OR, 0.27; 95% CI, 0.11-0.65) for Hispanic children than for non-Hispanic White children. Medicaid beneficiaries had lower odds of attending their referrals (OR, 0.20; 95% CI, 0.08-0.48) than privately insured children. Overall SVI score was not associated with receiving recommended polysomnography or tonsillectomy. Conclusion In our study, children living in areas of greater social vulnerability were less likely to attend their otolaryngology referral appointments for SDB evaluation, as were children of Black race, Hispanic ethnicity, and Medicaid beneficiaries. These results suggest that neighborhood conditions, as well as patient-level factors, influence patient access to SDB care.
ISSN:0194-5998
1097-6817
DOI:10.1177/01945998221084203