Influence of race and ethnicity on access to care among children with frequent ear infections.
OBJECTIVE
Determine the impact of racial/ethnic disparities on access to care for children with frequent ear infections (FEI). Identify disparities to target for intervention.


METHODS
Cross-sectional analysis of national database.


METHODS
Academic medical center.


METHODS
The National Health Interview Survey (1997 to 2006) was utilized to identify children with FEI (defined as three or more ear infections in the preceding year). Age, sex, race/ethnicity, income level, and insurance status were extracted. Access to care was measured by ability to afford medical care and prescription medications, specialist visitation, and emergency department visits. Multivariate analysis determined the influence of demographic variables on the ability to access health care resources.


RESULTS
An annualized population of 4.65 ± 0.08 million children reported FEI. Overall, 3.7 percent could not afford care, 5.6 percent could not afford prescriptions, and only 25.8 percent saw a specialist. A larger percentage of the black (42.7%) and Hispanic children (34.5%) with FEI were below the poverty level, versus white children (12.4%; P < 0.001); 18.2 percent of Hispanic children were uninsured, versus 6.5 percent of white children (P < 0.001). On multivariate analysis, children with FEI that were black or Hispanic had increased odds ratios relative to white children for 1) not being able to afford prescription medications (odds ratios [OR] 1.76 and 1.47, respectively; P < 0.002); 2) not being able to see a specialist (OR 1.62 and 1.86, respectively; P < 0.001); and 3) visiting the emergency department (OR 2.50 and 1.32, respectively; P < 0.001).


CONCLUSIONS
Racial/ethnic disparities among children with FEI significantly influence health care resource access and utilization. These disparities should be targeted for intervention.
Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA. neiloy@massmed.org
Neil
N
Bhattacharyya
Nina L
NL
Shapiro
Kalpesh T
KT
Vakharia
D000293:Adolescent; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010031:Otitis / Q000208:ethnology* / Q000628:therapy; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People