195 - Sociodemographic Disparities in Pediatric Obstructive Sleep Apnea Management

Poster Number: 195
Publication Number: 195.413

Ariel A. Williamson, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jungwon Min, Children's hospital of Philadelphia, Philadelphia, PA, United States; Xuemei Zhang, Children's Hospital of Philadelphia, Cherry Hill, NJ, United States; Heather Griffis, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Christopher Cielo, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Ignacio E. Tapia, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Untreated pediatric obstructive sleep apnea (OSA) poses significant risks to child health and wellbeing. Racial, ethnic, and socioeconomic disparities in OSA prevalence have been documented. However, little is known about sociodemographic disparities in OSA management.

Objective: To examine sociodemographic disparities in OSA management among newly diagnosed youth by (a) insurance coverage (Medicaid vs. commercial) and (b) child race and ethnicity among Medicaid-insured children.

Design/Methods: We examined clinical care 1-year following a first OSA diagnosis in youth ages 2-17 years in 2017 MarketScan insurance claims data. OSA management was defined as subspecialty pulmonary/otolaryngology visits, surgeries (adenotonsillectomy), positive airway pressure (PAP), and polysomnogram (PSG). Logistic regression models examined disparities in OSA management, adjusting for child age, gender, and complex chronic conditions. Race and ethnicity data were unavailable for the commercial claims.

Results: A total of 91,754 children with OSA were included (Medicaid-insured = 59%). Compared to commercially insured children, Medicaid-insured children had 50% reduced odds of subspecialty pulmonary/otolaryngology care post OSA diagnosis and 15% reduced odds of PAP prescriptions (Table 1). In Medicaid-insured youth, non-Latinx Black/African American (Black) children were more likely than non-Latinx White children to have subspecialty care visits, PSG, and PAP prescriptions, but not surgeries (Table 2). Compared to non-Latinx White youth, younger Black (2-11 years) and Hispanic/Latinx (2-5 years) children had a 20% decrease in odds of surgical treatment (Figure 1).Conclusion(s): Findings from insurance claims data in a large national sample suggest disparities in access to and engagement in OSA management post-diagnosis. Specifically, Medicaid-insured children are less likely to receive follow-up care compared to those with commercial insurance. Among Medicaid-insured youth, variation in OSA management by child race and ethnicity underscores the need to further evaluate potential family and cultural differences in OSA care decision-making.
Table 1. Differences in 1-year follow-up care after the first OSA diagnosis by insurance provider (n=91,754)
Table 2. Racial and ethnic differences in the rates and odds of 1-year follow-up care after the first OSA diagnosis among Medicaid patients (n=54,161)