title: Surgery for Otitis Media in a Universal Health Care Model: Socioeconomic Status and Race/Ethnicity Effects.
abstract: (1) To determine the association between socioeconomic status (SES), race/ethnicity, and other demographic risk factors in surgically managed otitis media within a model of universal health care. 2) To determine quality of life (QOL) outcomes of surgically managed otitis media in this model.
  
  
  
  Tertiary academic medical center.
  
  
  
  Prospective cohort study.
  
  
  
  A prospective study was conducted between June 2011 and December 2012 with dependent children of military families. TRICARE provides equal access to care among all beneficiaries regardless of a wide range of annual incomes. Caretakers of children scheduled for bilateral myringotomy and tympanostomy tube (BMT) placement were administered a demographic survey, as well as OM-6 QOL instrument preoperatively and 6 weeks postoperatively. A control group who did not undergo BMT was also administered both the survey and OM-6 for comparison.
  
  
  
  Two hundred forty patients were enrolled (120 surgical patients and 120 controls). Logistic regression demonstrated age younger than 6 years old (P < .001), day care attendance (P < .001), and non-Hispanic Caucasian race (P = .022) to be associated with surgery. Surgical QOL outcomes demonstrated a significant improvement in otitis media-6 (OM-6) scores after surgical management from 3.00 (95% confidence interval [CI], 2.79-3.20) to 1.35 (95% CI, 1.22-1.47).
  
  
  
  In a universal health care model serving more than 2 million children, previously reported proxies of low SES as well as minority race/ethnicity were not associated with surgically managed otitis media contrary to reported literature. Caucasian race, young age, and day care attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA ambrosio@ucla.edu.
authors.forename: Art
authors.initials: A
authors.lastname: Ambrosio
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brigger
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods; D008887:Military Medicine; D010033:Otitis Media / Q000208:ethnology* / Q000209:etiology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011203:Poverty; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*
keywords: CHAMPUS; TRICARE; ethnicity; otitis media; race; socioeconomic status; universal health care