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Study finds race, ethnicity impact access to care for children with frequent ear infections

Ear infections are one of the most common health problems for children, with most kids experiencing at least one by their third birthday. Annual costs in the United States alone are in the billions of dollars.

When these infections are left untreated, complications can include hearing loss, speech problems and more severe infections that can spread to bone and brain, causing meningitis. But not all kids have the same access to medical specialists and medicines.

A new study by researchers at the David Geffen School of Medicine at UCLA and Harvard Medical School has found that racial and ethnic disparities among children with frequent ear infections can significantly influence access to health care resources.

The findings, published in the November 2010 issue of the journal Otolaryngology—Head and Neck Surgery, show that compared with white children, African American and Hispanic children are at increased odds of not being able to afford prescription medications, not having medical insurance and not being able to see a specialist.

The study also shows that African American and Hispanic children are more likely than white children to visit the emergency room for an ear infection.

"Our goal was to provide an accurate demographic picture of the U.S. so that we could identify disparities to target for intervention," said study co-author Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children's Hospital UCLA and an associate professor of surgery at the Geffen School of Medicine. "Clearly, we found that children of certain ethnicities who suffer from frequent ear infections are more likely to face greater barriers to care. This information provides an opportunity for improvements in our current health care reform."

Researchers used data from a 10-year period (1997�) taken from the National Health Interview Survey, a large-scale, household-based survey of a statistically representative sample of the U.S. population.

Parents of children under the age of 18 were asked various questions, including whether their child had three or more ear infections over the previous 12 months. For those who answered yes, researchers pulled demographic data — including age, sex, race/ethnicity, income level and insurance status — to determine the influence of these variables on frequent ear infections.

The study found that each year, 4.6 million children reportedly had "frequent" ear infections —defined as more than three infections over a 12-month period. Overall, 3.7 percent of children with frequent ear infections could not afford care, 5.6 percent could not afford prescriptions and only 25.8 percent saw a specialist.

Among the study's other findings for children with frequent ear infections:

A greater percentage of African American children (42.7 percent) and Hispanic children (34.5 percent) lived below the poverty level than white children (12.0 percent) and those of "other ethnicity" (28.0 percent).

A greater percentage of Hispanic children (18.2 percent) and "other ethnicity" children (16.6 percent) were uninsured, compared with whites (6.5 percent).

A greater percentage of white children (29.2 percent) reported having access to specialty care than African American children (20.0 percent), Hispanic children (17.5 percent) and "other ethnicity" children (18.9 percent).

A greater percentage of African American children (28.4 percent) and Hispanic children (19.8 percent) visited the emergency room at least twice for ear infections over a 12-month period than white children (15.5 percent).

"Emergency room visits for ear infections by African American and Hispanic children may represent their source of primary care services, which is more costly and a significant burden on the health care system," Shapiro said. "This finding, along with the fact that fewer Hispanic and African American children were insured or received specialty care, highlights the importance of targeting interventions that help children with frequent ear infections."

The next stage of the research is to follow the racial and ethnic groups prospectively and to monitor whether changes stemming from health care reform influence disparities in these groups over time.

Co-authors of the study included Dr. Kalpesh T. Vakharia of the Massachusetts Eye and Ear Infirmary and Harvard Medical School, and Dr. Neil Bhattacharyya, of Brigham and Women's Hospital and Harvard Medical School.

The research was not funded. Bhattacharyya is a consultant for Intellus and Intersect ENT, and Shapiro is a consultant for ArthroCare ENT. Vakhaira has no disclosures.

Amy Albin | EurekAlert!
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