title: Trends in otitis media-related health care use in the United States, 2001-2011.
abstract: OBJECTIVE
  Otitis media (OM) is a leading cause of pediatric health care visits and the most frequent reason children consume antibiotics or undergo surgery. During recent years, several interventions have been introduced aiming to decrease OM burden.
  
  
  OBJECTIVE
  To study the trend in OM-related health care use in the United States during the pneumococcal conjugate vaccine (PCV) era (2001-2011).
  
  
  METHODS
  An analysis of an insurance claims database of a large, nationwide managed health care plan was conducted. Enrolled children aged 6 years or younger with OM visits were identified.
  
  
  METHODS
  Annual OM visit rates, OM-related complications, and surgical interventions were analyzed.
  
  
  RESULTS
  Overall, 7.82 million unique children (5.51 million child-years) contributed 6.21 million primary OM visits; 52% were boys and 48% were younger than 2 years. There was a downward trend in OM visit rates from 2004 to 2011, with a significant drop that coincided with the advent of the 13-valent vaccine (PCV-13) in 2010. The observed OM visit rates in 2010 (1.00/child-year) and 2011 (0.81/child-year) were lower than the projected rates based on the 2005-2009 trend had there been no intervention (P < .001). Recurrent OM (≥3 OM visits within 6-month look-back) rates decreased at 0.003/child-year (95% CI, 0.002-0.004/child-year) in 2001-2009 and at 0.018/child-year (95% CI, 0.008-0.028/child-year) in 2010-2011. In the PCV-13 premarket years, there was a stable rate ratio (RR) between OM visit rates in children younger than 2 years and in those aged 2 to 6 years (RR, 1.38; 95% CI, 1.38-1.39); the RR decreased significantly (P < .001) during the transition year 2010 (RR 1.32; 95% CI, 1.31-1.33) and the postmarket year 2011 (RR 1.01; 95% CI, 1.00-1.02). Tympanic membrane perforation/otorrhea rates gradually increased (from 3721 per 100,000 OM child-years in 2001 to 4542 per 100,000 OM child-years in 2011; P < .001); the increase was significant only in the older children group. Mastoiditis rates substantially decreased (from 61 per 100,000 child-years in 2008 to 37 per 100,000 child-years in 2011; P < .001). Ventilating tube insertion rate decreased by 19% from 2010 to 2011 (P = .03).
  
  
  CONCLUSIONS
  There was an overall downward trend in OM-related health care use from 2001 to 2011. The significant reduction in OM visit rates in 2010-2011 in children younger than 2 years coincided with the advent of PCV-13. Although tympanic membrane perforation/otorrhea rates steadily increased during that period, mastoiditis and ventilating tube insertion rates decreased in the last years of the study.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, The University of Texas Medical Branch, Galveston.
authors.forename: Tal
authors.initials: T
authors.lastname: Marom
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston.
authors.forename: Alai
authors.initials: A
authors.lastname: Tan
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Wilkinson
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pierson
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Freeman
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, The University of Texas Medical Branch, Galveston3Department of Pathology, The University of Texas Medical Branch, Galveston.
authors.forename: Tasnee
authors.initials: T
authors.lastname: Chonmaitree
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000639:trends*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D014481:United States
chemical_list: C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines