Socioeconomic Status and Otitis Media in a Universal Healthcare Model

Abstract

Objectives:

1) Determine the association between socioeconomic status (SES) and other risk factors in surgically managed otitis media within a model of universal healthcare. 2) Determine quality of life (QOL) outcomes of surgically managed otitis media in the Tricare health system.

Methods:

A prospective cross-sectional study was conducted between June 2011 and December 2012 with dependent children of military families. Tricare provides equal access to care among all beneficiaries despite a wide range of income and education across enrollment. Caretakers of children scheduled for bilateral myringotomy and tympanostomy tube (BMT) placement were administered a demographic survey that encompassed proxies for SES and risk factors for otitis media. The validated OM-6 QOL instrument was administered upon enrollment and 6 weeks postoperatively. The survey and OM-6 were administered to a comparison group who did not undergo BMT. Categorical variables associated with BMT were analyzed by logistic regression, and OM-6 scores were compared by non-parametric tests of hypotheses.

Results:

120 children undergoing BMT were enrolled. Logistic regression demonstrated age less than 2 years old (P < 0.001), daycare attendance (P < 0.001), and Caucasian ethnicity (P = 0.001) as associated with surgery. Surgical QOL outcomes demonstrated a significant improvement in OM-6 scores after surgical management from 11.7 (95% confidence interval [CI]: 10.5,12.9) to 2.2 (95% CI: 1.4,2.9).

Conclusions:

In a universal healthcare model serving over 2 million children, previously reported proxies of low SES were not associated with surgically managed otitis media contrary to reported literature. Caucasian ethnicity, young age, and daycare attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.