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October 03, 2020
10/3/2020 1:00:00 PM - 10/3/2020 2:00:00 PM
Room Virtual
Racial Disparities And Socioeconomic Factors Associated With Receipt Of Surgery Among Children: 1999-2018
Ethan Sanford, M.D., Rasmi L. Nair, Ph.D., Adam Alder, M.D., Peter Szmuk, M.D.
UT Southwestern Medical Center, DALLAS, Texas, United States
Disclosures: E. Sanford: None. R.L. Nair: None. A. Alder: None. P. Szmuk: None.
IntroductionDisparities in healthcare access prevent uniform distribution of the best possible care to all individuals. Accessing pediatric surgical care requires parents to navigate complex healthcare systems. Disparities in comprehension, socioeconomics, and provider biases may disproportionately impact different racial and ethnic groups. Pediatric surgical disparities are largely unknown as studies are limited to specific pathology or are single center with minimal assessment of sociodemographic variables1-3. Larger studies of pediatric surgical epidemiology are limited to either inpatient or outpatient database studies without assessment of patient racial or socioeconomic associations4,5. Here, we report a nationally representative health survey to assess disparities in pediatric surgical care in the United States from 1999-2018.MethodsThe National Health Interview Survey (NHIS) assesses a range of health statuses and utilization measures among a cross-sectional, geographically representative cohort of persons living in the United States6. Harmonized NHIS data from 1999-2018 were obtained through the Integrated Health Interview Series7. The institutional review board of University of Texas Southwestern Medical Center deemed studies utilizing the NHIS exempt from review.Survey participants older than 18 years or with incomplete variable data were excluded. The primary variable was receipt of surgery within the preceding 12 months. Survey participants were asked: “During the past 12 months, has sample child had surgery or other surgical procedures either as an inpatient or outpatient?”. Additional covariables included insurance status, poverty, home ownership, citizenship, healthcare utilization, race, ethnicity, sex, language, region, era of survey and parental education.

Multivariable logistic regression defined the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for receipt of surgery for the entire cohort. A multiplicative multivariable logistic regression model was used to test for an interaction between Hispanic ethnicity and maternal education. Sample weighting stratified by year was used to limit year-to-year sampling variance. ResultsData for 227,025 children under 18 years were analyzed. 11,018 (4.9%) received surgery in the prior 12 months. Non-Hispanic Black (AOR 0.58, 95% CI 0.53-0.63), Asian (AOR 0.42, 95% CI 0.36-0.49), and Hispanic (AOR 0.65, 95% CI 0.60-0.71) children were less likely to have surgery than non-Hispanic white children (Table 1). Lack of maternal high school degree was associated with greater decreased AOR for surgery among Hispanic (0.78, 95% CI 0.67-0.91) as compared to non-Hispanic (0.96, 95% CI 0.86-1.07) children with a significant interaction p-value of 0.002 (Table 2).SummaryHispanic, non-Hispanic Black, and Asian children were less likely to have surgery than non-Hispanic White children from 1999-2018 after adjusting for relevant covariables. Low maternal education decreased the odds of surgery more among Hispanic than non-Hispanic children, possibly indicating an arena for intervention. Racial and ethnic disparities in pediatric surgery may result in worsened outcomes of surgical pathology.
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