title: Socioeconomic disparities in the presentation of acute bacterial sinusitis complications in children.
abstract: OBJECTIVE
  To identify characteristics and disparities associated with presentation of pediatric acute bacterial sinusitis (ABS) complications.
  
  
  METHODS
  A cross-sectional study of the 2008 Nationwide Emergency Department Sample database.
  
  
  METHODS
  A total of 101,660 children 18 years of age or younger diagnosed with ABS, 696 of whom had orbital or intracranial complications, were identified. Patient and hospital-specific characteristics were investigated for association with childhood ABS complications.
  
  
  RESULTS
  Orbital and intracranial complications occurred in 0.7% of children with ABS. Such complications were more common in boys (odds ratio [OR]: 1.65, P<.001) and children with chronic rhinosinusitis (OR: 7.89, P<.001), and were associated with presentation to metropolitan teaching (OR: 2.15, P<.001) and nonteaching (OR: 14.39, P<.001) hospitals. Orbital complications were associated with younger age (OR: 0.96, P<.001), whereas intracranial complications were associated with older age (OR: 1.11, P<.001). A dichotomy in socioeconomic background differentiated children with orbital ABS complications from those with intracranial complications. Although orbital complications were associated with higher income (OR: 2.13, P<.001) and private insurance (OR: 1.36, P=.003), intracranial complications were associated with Medicaid (OR: 2.96, P<.001) or no insurance at all (OR: 3.73, P=.001).
  
  
  CONCLUSIONS
  Socioeconomic disparities exist in presentation of ABS complications in children. Although hinted at by the association with urban/metropolitan hospitals, explicit evidence is provided by association of intracranial complications with markers of low socioeconomic status and poor access to healthcare. Efforts to aid early diagnosis and treatment should target providers in metropolitan areas who treat children of lower socioeconomic status. Such interventions will ideally improve outcomes and limit healthcare costs related to the high morbidity of pediatric ABS complications.
  
  
  METHODS
  2b.
authors: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors: Ahmad R
authors: AR
authors: Sedaghat
authors: Claus O
authors: CO
authors: Wilke
authors: Michael J
authors: MJ
authors: Cunningham
authors: Stacey L
authors: SL
authors: Ishman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001922:Brain Abscess / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D054517:Orbital Cellulitis / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications* / Q000382:microbiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Sinusitis; brain abscess; healthcare disparities; orbital cellulitis; pediatrics