title: Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities.
abstract: To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities.
  
  
  
  Retrospective administrative database analysis.
  
  
  
  US-based outpatient settings.
  
  
  
  All patients from the MarketScan Medicaid database with endoscopic sinus surgery from 2009 to 2013 were stratified by ethnicity, age (5-year increments, as per US Census), and sex. Crude rates of endoscopic sinus surgery per age group and sex were compiled for all patients and each ethnic group (African American, Caucasian, Hispanics, and others). Age and sex standardization was done with the MarketScan Medicaid overall population as standard. The coefficient of variation, extremal ratio, and chi-square statistics were calculated to determine variation across ethnicities.
  
  
  
  Overall sinus surgery rates per 1000 people in the Medicaid population ranged from 0.36 to 0.40 from 2009 to 2013 (African Americans: 0.24-0.26; Hispanics: 0.21-0.37; Caucasians: 0.47-0.56; rate of surgery statistically lower for African American vs Hispanics for 4 of 5 years). The coefficient of variation and extremal ratio ranged from 29.3% to 45.6% and 1.98 to 2.6, respectively. Differences among groups were significant for all years (P < .0001). Comparison of sex-adjusted ratios by age group demonstrated greater rates of surgery in the Caucasian group versus other groups for all age categories.
  
  
  
  The Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA woodart@ccf.org.
authors.forename: Troy
authors.initials: T
authors.lastname: Woodard
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ashleigh A
authors.initials: AA
authors.lastname: Halderman
authors.affiliation: Acclarent Inc, Menlo Park, California, USA.
authors.forename: Chantal E
authors.initials: CE
authors.lastname: Holy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Healthcare System, Charlottesville, Virginia, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Gurrola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000208:ethnology* / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: access to care; administrative database; endoscopic sinus surgery; ethnicity; inequity