Health Disparities in the Access and Cost of Health Care for Otolaryngologic Conditions. (April 2020)

• Record Type: Journal Article
• Authors: Ruthberg, Jeremy S.; Khan, Hammad A.; Knusel, Konrad D.; Rabah, Nicholas M.; Otteson, Todd D.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 162:Number 4(2020)
• Page Start: 479
• Page End: 488
• Publication Date: 2020-04
• Subjects: Otolaryngology -- health disparities -- socioeconomic differences -- race; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820904369
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To demonstrate whether race, education, income, or insurance status influences where patients seek medical care and the cost of care for a broad range of otolaryngologic diseases in the United States. Study Design: Retrospective cohort study using data from the Medical Expenditure Panel Survey, from 2007 to 2015. Setting: Nationally representative database. Subjects and Methods: Patients with 14 common otolaryngologic conditions were identified using self-reported data and International Classification of Diseases, 9th Revision Clinical Modification diagnosis codes. To analyze disparities in the utilization and cost of otolaryngologic care, a multivariate logistic regression model was used to compare outpatient and emergency department visit rates and costs for African American, Hispanic, and Caucasian patients, controlling for sociodemographic characteristics. Results: Of 78, 864 respondents with self-reported otolaryngologic conditions, African American and Hispanic patients were significantly less likely to visit outpatient otolaryngologists than Caucasians (African American: adjusted odds ratio [aOR], 0.57; 95% CI, 0.5-0.65; Hispanic: aOR, 0.64; 95% CI, 0.56-0.73) and reported lower average costs per emergency department visit than Caucasians (African American: $4013.67; Hispanic: $3906.21; Caucasian: $7606.46; P < .001). In addition, uninsured, low-income patients without higher education were significantly less likely to receive outpatient otolaryngologic care than privately insured, higher-income, and more educated individuals (uninsured: aOR, 0.38; 95% CI, 0.29-0.51; poor: aOR, 0.75; 95% CI, 0.64-0.87; no degree: aOR, 0.67; 95% CI, 0.54-0.82). Conclusion: In this study, significant racial and socioeconomic discrepancies exist in the utilization and cost of health care for otolaryngologic conditions in the United States.