title: Grommets, tonsillectomies, and deprivation in Scotland.
abstract: OBJECTIVE
  To see whether there is a relation between grommet insertion operation and tonsillectomy rates, otolaryngology services, and deprivation scores in Scotland.
  
  
  METHODS
  Analysis of routine 1990 NHS data on grommet insertions and tonsillectomies in Scottish children aged 0-15 years compared with data on general practitioner and otolaryngology services and Carstairs deprivation scores.
  
  
  METHODS
  All 15 Scottish health boards.
  
  
  METHODS
  All children aged 0-15 (1,021,933).
  
  
  RESULTS
  Tonsillectomy was more common than grommet insertion operations in Scotland (6182:4850). Health boards with high grommet insertion rates were more likely to have low tonsillectomy rates (Spearman's rank correlation -0.59; 95% confidence interval -0.87 to -0.03). Grommet insertion rates varied fourfold (from 2.4/1000 to 9.2/1000) and tonsillectomy rates twofold (from 3.6/1000 to 8.0/1000) across Scottish health boards. Variation between health boards had changed over the 15 years 1975-90. Variation in grommet insertion rates did not reflect variation in the supply of otolaryngology consultants (Spearman's rank correlation -0.25). There was a non-significant tendency for high general practitioner referral rates to be associated with high grommet insertion rates, low tonsillectomy rates, and less deprived areas (Spearman's rank correlation coefficients 0.50, -0.53, and -0.43). Deprivation (measured by Carstairs scoring for each health board) was associated with higher tonsillectomy rates (Spearman's rank correlation 0.41; 95% confidence interval -0.22 to 0.80) and significantly lower grommet insertion rates (-0.73; -0.92 to -0.28).
  
  
  CONCLUSIONS
  Social factors as well as differences in disease prevalence and medical practice need to be considered when studying variation in childhood grommet insertion and tonsillectomy rates.
authors.affiliation: Department of Public Health Medicine, Grampian Health Board, Aberdeen.
authors.forename: A F
authors.initials: AF
authors.lastname: Bisset
authors.forename: D
authors.initials: D
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008876:Middle Ear Ventilation / Q000706:statistics & numerical data*; D011203:Poverty; D012017:Referral and Consultation; D012086:Reoperation; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D013997:Time Factors; D014068:Tonsillectomy / Q000706:statistics & numerical data*; D014850:Waiting Lists