Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities

Troy Woodard, Raj Sindwani, Ashleigh A. Halderman, Chantal E. Holy, Jose Gurrola

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. Study Design Retrospective administrative database analysis. Setting US-based outpatient settings. Methods 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. Results 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)944-950
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume154
Issue number5
DOIs
StatePublished - Jan 1 2016

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Medicaid
Population
Hispanic Americans
African Americans
Age Groups
Databases
Ethnic Groups
Health Services Accessibility
Sex Ratio
Censuses
Outpatients
Retrospective Studies
Research

Keywords

  • access to care
  • administrative database
  • endoscopic sinus surgery
  • ethnicity
  • inequity

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities. / Woodard, Troy; Sindwani, Raj; Halderman, Ashleigh A.; Holy, Chantal E.; Gurrola, Jose.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 154, No. 5, 01.01.2016, p. 944-950.

Research output: Contribution to journalArticle

Woodard, Troy ; Sindwani, Raj ; Halderman, Ashleigh A. ; Holy, Chantal E. ; Gurrola, Jose. / Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities. In: Otolaryngology - Head and Neck Surgery (United States). 2016 ; Vol. 154, No. 5. pp. 944-950.
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abstract = "Objective To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. Study Design Retrospective administrative database analysis. Setting US-based outpatient settings. Methods 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. Results 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. Conclusion 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.",
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AB - Objective To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. Study Design Retrospective administrative database analysis. Setting US-based outpatient settings. Methods 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. Results 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. Conclusion 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.

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