{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:29Z","timestamp":1777877549757,"version":"3.51.4"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Department of Otolaryngology- Head and Neck Surgery, Western University, London, Ontario, Canada","award":["Catalyst Grant"],"award-info":[{"award-number":["Catalyst Grant"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Despite efforts to ensure equitable access to medically necessary services, disparities in care may persist in pediatric otolaryngology services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the relationship between socioeconomic marginalization and surgical wait times for tympanostomy tube insertion in the healthcare system of Ontario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Population-based, retrospective cohort study utilizing administrative health data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients \u226412\u2009years who underwent bilateral tympanostomy tube insertion between 2010 and 2023 were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Socioeconomic marginalization measured by the Ontario Marginalization Index, rurality and immigrant status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>ENT visit within 90\u2009days of surgery, age at ENT visit, time from ENT visit to surgery, number of ENT visits during each year of follow-up, time to tympanostomy tube removal, and delayed tympanostomy tube removal (\u22655\u2009years post-surgery).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 76,574 tympanostomy tube patients were analyzed. As compared to the least marginalized patients, the most marginalized patients were significantly less likely to have an ENT visit within 90\u2009days of surgery (75% vs 81.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). The number of emergency department visits (1: \u221215%, \u22652: \u221229%) was protective, decreasing age at ENT visit (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Furthermore, rural residence significantly increased the risk of higher age at ENT visit (+7%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Immigrant children were older at their final ENT visit and had longer surgical wait times compared to non-immigrant children (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Significant disparities exist in accessing tympanostomy tubes; socioeconomic marginalization, prior emergency department visits, sex, immigrant and rural status delaying the age at final ENT visit before surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>These findings underscore the need for targeted strategies to improve equitable access to pediatric ENT services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216261422572","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:00:38Z","timestamp":1773828038000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Marginalization Impact Access to Tympanostomy Tube Insertion in Pediatric Patients in Ontario?"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3546-8407","authenticated-orcid":false,"given":"Camille","family":"Duggal","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Britney","family":"Le","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Andrew","family":"McClure","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blayne","family":"Welk","sequence":"additional","affiliation":[{"name":"Division of Urology, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit","family":"Dave","sequence":"additional","affiliation":[{"name":"Division of Urology, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5460-3155","authenticated-orcid":false,"given":"Julie","family":"Strychowsky","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, University of Western Ontario, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Senate of Canada. Chapter Seventeen: The Canada Health Act. December 23 2022. Accessed November 3 2024. https:\/\/sencanada.ca\/en\/content\/sen\/committee\/372\/soci\/rep\/repoct02vol6part7-e."},{"key":"e_1_3_3_3_2","article-title":"Clinical practice guideline: tympanostomy tubes in children (update)","volume":"166","author":"Rosenfeld RM","year":"2022","unstructured":"Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022;166(1_suppl):S1-S55.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_3_3_4_2","unstructured":"Health Quality Ontario. System performance: measuring pediatric wait times for surgery. January 2 2023. Accessed November 5 2024. https:\/\/www.hqontario.ca\/System-Performance\/Measuring-System-Performance\/Measuring-Pediatric-Wait-Times-for-Surgeries."},{"key":"e_1_3_3_5_2","unstructured":"Public Health Ontario. Ontario Marginalization Index (ON-Marg). December 22 2022. Accessed November 12 2024. https:\/\/www.publichealthontario.ca\/en\/Data-and-Analysis\/Health-Equity\/Ontario-Marginalization-Index."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/03610910902859574"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-020-1977-6"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002145"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818760562"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/OI9.0000000000000202"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2235042X18814939"}],"container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216261422572","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19160216261422572","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216261422572","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:54:36Z","timestamp":1777589676000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19160216261422572"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":10,"alternative-id":["10.1177\/19160216261422572"],"URL":"https:\/\/doi.org\/10.1177\/19160216261422572","relation":{},"ISSN":["1916-0216","1916-0216"],"issn-type":[{"value":"1916-0216","type":"print"},{"value":"1916-0216","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"19160216261422572"}}