{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:46:31Z","timestamp":1787985991660,"version":"build-2784847793"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec id=\"ab-ooi220072-4\"><jats:title>Importance<\/jats:title><jats:p>It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-5\"><jats:title>Objective<\/jats:title><jats:p>To describe and quantify social disparities in the treatment patterns of otitis media in children in the US.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4\u202f831\u202f408 children with otitis media.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-7\"><jats:title>Exposures<\/jats:title><jats:p>Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-9\"><jats:title>Results<\/jats:title><jats:p>Among 4\u202f831\u202f408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994\u202f921 (20.59%) were treated for recurrent otitis media, 717\u202f978 (14.86%) were treated for suppurative otitis media, 335\u202f949 (6.95%) received tympanostomy tubes, and 10\u202f975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi220072-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2022.3560","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T16:01:06Z","timestamp":1668096066000},"page":"7","source":"Crossref","is-referenced-by-count":22,"title":["Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance"],"prefix":"10.1001","volume":"149","author":[{"given":"Z. Jason","family":"Qian","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Rehkopf","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"23","key":"ooi220072r1","doi-asserted-by":"publisher","first-page":"3096","DOI":"10.1001\/jama.287.23.3096","article-title":"Trends in antimicrobial prescribing rates for children and adolescents.","volume":"287","author":"McCaig","year":"2002","journal-title":"JAMA"},{"issue":"7","key":"ooi220072r2","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1001\/jama.2009.1163","article-title":"Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings.","volume":"302","author":"Grijalva","year":"2009","journal-title":"JAMA"},{"issue":"4","key":"ooi220072r3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0036226","article-title":"Burden of disease caused by otitis media: systematic review and global estimates.","volume":"7","author":"Monasta","year":"2012","journal-title":"PLoS One"},{"key":"ooi220072r4","doi-asserted-by":"publisher","first-page":"16063","DOI":"10.1038\/nrdp.2016.63","article-title":"Otitis media.","volume":"2","author":"Schilder","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"ooi220072r5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0086397","article-title":"Risk factors for chronic and recurrent otitis media\u2014a meta-analysis.","volume":"9","author":"Zhang","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"ooi220072r6","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1542\/peds.99.3.318","article-title":"Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life.","volume":"99","author":"Paradise","year":"1997","journal-title":"Pediatrics"},{"issue":"1","key":"ooi220072r7","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/00006454-198601000-00006","article-title":"Risk factors for recurrent otitis media.","volume":"5","author":"St\u00e5hlberg","year":"1986","journal-title":"Pediatr Infect Dis"},{"issue":"3 Pt 1","key":"ooi220072r8","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1542\/peds.112.3.514","article-title":"Trends in otitis media among children in the United States.","volume":"112","author":"Auinger","year":"2003","journal-title":"Pediatrics"},{"issue":"8","key":"ooi220072r9","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1002\/lary.v120:8","article-title":"Demographic disparities among children with frequent ear infections in the United States.","volume":"120","author":"Vakharia","year":"2010","journal-title":"Laryngoscope"},{"issue":"11","key":"ooi220072r10","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1002\/lary.v120:11","article-title":"Racial\/ethnic and socioeconomic disparities in the prevalence and treatment of otitis media in children in the United States.","volume":"120","author":"Smith","year":"2010","journal-title":"Laryngoscope"},{"issue":"4","key":"ooi220072r11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0215483","article-title":"Australian Aboriginal children have higher hospitalization rates for otitis media but lower surgical procedures than non-Aboriginal children: a record linkage population-based cohort study.","volume":"14","author":"Westphal","year":"2019","journal-title":"PLoS One"},{"issue":"9","key":"ooi220072r12","doi-asserted-by":"publisher","first-page":"e817","DOI":"10.1097\/MAO.0000000000001943","article-title":"Interplay between socioeconomic status and otitis media disease burden in resource-rich and resource-poor nations.","volume":"39","author":"Guys","year":"2018","journal-title":"Otol Neurotol"},{"issue":"1","key":"ooi220072r13","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1186\/s12889-020-08570-3","article-title":"The social determinants of otitis media in Aboriginal children in Australia: are we addressing the primary causes? A systematic content review.","volume":"20","author":"DeLacy","year":"2020","journal-title":"BMC Public Health"},{"issue":"2","key":"ooi220072r14","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2105\/AJPH.90.2.245","article-title":"Factors associated with tympanostomy tube insertion among preschool-aged children in the United States.","volume":"90","author":"Kogan","year":"2000","journal-title":"Am J Public Health"},{"issue":"1","key":"ooi220072r15","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.acap.2016.07.004","article-title":"Racial and ethnic differences in receipt of pressure equalization tubes among US children, 2014.","volume":"17","author":"Simon","year":"2017","journal-title":"Acad Pediatr"},{"issue":"1","key":"ooi220072r16","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599813490141","article-title":"Clinical practice guideline: tympanostomy tubes in children.","volume":"149","author":"Rosenfeld","year":"2013","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1_suppl","key":"ooi220072r17","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/01945998211065662","article-title":"Clinical practice guideline: tympanostomy tubes in children (update).","volume":"166","author":"Rosenfeld","year":"2022","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"9","key":"ooi220072r18","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1093\/aje\/kwj313","article-title":"Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: a multilevel analysis of Massachusetts births, 1989-1991.","volume":"164","author":"Subramanian","year":"2006","journal-title":"Am J Epidemiol"},{"issue":"10","key":"ooi220072r19","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.2105\/AJPH.93.10.1655","article-title":"Race\/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures\u2014the public health disparities geocoding project.","volume":"93","author":"Krieger","year":"2003","journal-title":"Am J Public Health"},{"issue":"12","key":"ooi220072r20","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.2105\/AJPH.2005.075408","article-title":"Monitoring socioeconomic disparities in death: comparing individual-level education and area-based socioeconomic measures.","volume":"96","author":"Rehkopf","year":"2006","journal-title":"Am J Public Health"},{"issue":"2 Pt 1","key":"ooi220072r21","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/hesr.2013.48.issue-2pt1","article-title":"Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery.","volume":"48","author":"Butler","year":"2013","journal-title":"Health Serv Res"},{"issue":"12","key":"ooi220072r25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111732","article-title":"Incidence of otitis media in a contemporary Danish national birth cohort.","volume":"9","author":"Todberg","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"ooi220072r26","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1001\/jamaoto.2014.3581","article-title":"The role of gastric pepsin in the inflammatory cascade of pediatric otitis media.","volume":"141","author":"O\u2019Reilly","year":"2015","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi220072r27","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1001\/archpedi.156.2.147","article-title":"Effect of gestational and passive smoke exposure on ear infections in children.","volume":"156","author":"Lieu","year":"2002","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"1","key":"ooi220072r28","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1288\/00005537-197901000-00003","article-title":"Epidemiology of otitis media\u2014an interracial study.","volume":"89","author":"Griffith","year":"1979","journal-title":"Laryngoscope"},{"issue":"6","key":"ooi220072r29","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.6.e72","article-title":"Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric Medicaid cohort.","volume":"105","author":"Bondy","year":"2000","journal-title":"Pediatrics"},{"issue":"6","key":"ooi220072r30","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1097\/INF.0b013e318217dc6e","article-title":"Crowding and other strong predictors of upper respiratory tract carriage of otitis media-related bacteria in Australian Aboriginal and non-Aboriginal children.","volume":"30","author":"Jacoby","year":"2011","journal-title":"Pediatr Infect Dis J"},{"issue":"11","key":"ooi220072r31","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003807","article-title":"Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study.","volume":"3","author":"Falster","year":"2013","journal-title":"BMJ Open"},{"issue":"3","key":"ooi220072r32","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1377\/hlthaff.2012.0691","article-title":"Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups.","volume":"32","author":"Abdus","year":"2013","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"ooi220072r33","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1002\/lary.v127.1","article-title":"The geographic distribution of the otolaryngology workforce in the United States.","volume":"127","author":"Lango","year":"2017","journal-title":"Laryngoscope"},{"issue":"7370","key":"ooi220072r34","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1136\/bmj.325.7370.961","article-title":"Unwarranted variations in healthcare delivery: implications for academic medical centres.","volume":"325","author":"Wennberg","year":"2002","journal-title":"BMJ"},{"issue":"2","key":"ooi220072r35","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.acap.2012.01.001","article-title":"Perceived barriers to care and attitudes towards shared decision-making among low socioeconomic status parents: role of health literacy.","volume":"12","author":"Yin","year":"2012","journal-title":"Acad Pediatr"},{"key":"ooi220072r36","doi-asserted-by":"publisher","first-page":"a1607","DOI":"10.1136\/bmj.a1607","article-title":"Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort.","volume":"337","author":"Keyhani","year":"2008","journal-title":"BMJ"},{"issue":"3","key":"ooi220072r37","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-053129","article-title":"Telehealth: improving access to and quality of pediatric health care.","volume":"148","author":"Curfman","year":"2021","journal-title":"Pediatrics"},{"key":"ooi220072r22","unstructured":"Social deprivation index (SDI). Robert Graham Center. Accessed December 7, 2021. https:\/\/www.graham-center.org\/rgc\/maps-data-tools\/sdi\/social-deprivation-index.html"},{"key":"ooi220072r23","unstructured":"CDC\/ATSDR social vulnerability index (SVI). Agency for Toxic Substances and Disease Registry. March 15, 2022. Accessed April 11, 2022. https:\/\/www.atsdr.cdc.gov\/placeandhealth\/svi\/index.html"},{"key":"ooi220072r24","unstructured":"HUD USPS zip code crosswalk files. Office of Policy Development and Research. Accessed December 7, 2021. https:\/\/www.huduser.gov\/portal\/datasets\/usps_crosswalk.html"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2798548\/jamaotolaryngology_qian_2022_oi_220072_1672856052.73494.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T16:39:42Z","timestamp":1673541582000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2798548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,1]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2022.3560","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1,1]]}}}