Racial and Ethnic Disparities in Care for Pediatric Sleep‐Disordered Breathing

Objective: Obstructive sleep disordered breathing is the most common indication for pediatric tonsillectomy in the United States, but there are barriers to specialty care that may contribute to disparities in tonsillectomy use. This study examined the association between race, ethnicity, urban/rural residence, and other factors in access to specialty care for children diagnosed with obstructive sleep disordered breathing. Study Design: Retrospective observational cohort study. Setting: Fifteen states participating in the United States Medicaid and Child Health Insurance Programs. Methods: Children ages 2 to 18 years from 2017 to 2018 with a diagnosis of obstructive sleep disordered breathing followed for 1 year to ascertain receipt of polysomnography, otolaryngology specialist visit, and tonsillectomy. Results: This study included 304,415 children with diagnosis of obstructive sleep disordered breathing. Care pathways differed by race and ethnicity; Black non-Hispanic and Hispanic children were more likely to undergo polysomnography, either alone or with other forms of care (adjusted rate ratios and 95% confidence intervals 1.06 [1.04-1.09] and 1.06 [1.04-1.08], respectively). White non-Hispanic children, on the other hand, were more likely to receive otolaryngology care and/or tonsillectomy without polysomnography (Black non-Hispanic: 0.97 [0.95-0.99], Hispanic: 0.93 [0.92-0.95]). Urban children were more likely to undergo polysomnography alone and polysomnography prior to otolaryngology care (Urban: 1.06 [1.03-1.09], relative to rural). Conclusion: Black non-Hispanic, Hispanic, and urban children were more likely to undergo polysomnography and less likely to have tonsillectomy in absence of polysomnography. These differences suggest potential unwarranted variation in diagnostic and surgical care across race/ethnic groups and urban/rural settings.