The impact of social determinants of health on pediatric tonsillectomy

Abstract

Objective

To determine if health disparities impact pediatric tonsillectomy rates.

Introduction

Inequities in pediatric tonsillectomy have been identified in individual studies, however, a systematic review characterizing how the specific social determinants of health impact differences in receipt of pediatric tonsillectomy is needed.

Data sources

PubMed, Scopus, and CINAHL databases.

Review methods

A systematic review was performed in accordance with the PRISMA guidelines. The literature search aimed to capture all articles published through August 2022. Included articles evaluated tonsillectomy for the treatment of tonsillitis and/or obstructive sleep-disordered breathing in patients less than 21 years in which one or more social determinants of health were evaluated.

Results

A total of 801 unique articles were identified. Of those, 22 met inclusion criteria. Eight studies (36 %) evaluated tonsillectomy in the context of race, of which all showed that Black children underwent tonsillectomy at significantly lower rates than their White counterparts. Nine studies (41 %) evaluated insurance status, with population-based studies concluding that tonsillectomy utilization was higher in patients with public insurance. Studies of race and insurance were all from the United States. Eight studies (36 %) assessed socioeconomic status and six (28 %) assessed geographic location; however, these latter factors were difficult to compare given the varying metrics and locations among studies.

Conclusion

This systematic review shows that Black children undergo tonsillectomy at lower rates than White children, and children with public insurance undergo tonsillectomy at higher rates than children with other insurance types in the United States. Findings for rurality and socioeconomic status were heterogenous given regional and national differences in study settings.

Level of evidence

I.