TY - JOUR
T1 - Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities
AU - Woodard, Troy
AU - Sindwani, Raj
AU - Halderman, Ashleigh A.
AU - Holy, Chantal E.
AU - Gurrola, Jose
N1 - Publisher Copyright:
© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2016.
PY - 2016/5
Y1 - 2016/5
N2 - 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.
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.
KW - access to care
KW - administrative database
KW - endoscopic sinus surgery
KW - ethnicity
KW - inequity
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U2 - 10.1177/0194599816628460
DO - 10.1177/0194599816628460
M3 - Article
C2 - 26908562
AN - SCOPUS:84968902035
SN - 0194-5998
VL - 154
SP - 944
EP - 950
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 5
ER -