(128) Time Is Money: Socioeconomic Disparities in Tonsillectomy Access

Introduction: Socioeconomic status (SES) and insurance status influence healthcare access and outcomes. In pediatric otolaryngology, disparities in surgical timing and patient burden remain underexplored. This study investigates the impact of insurance type and SES on tonsillectomy access using time-based metrics and demographic indicators.

Methods: A retrospective cohort analysis was conducted on pediatric patients undergoing tonsillectomy. Patients were grouped by insurance status (Group 1: no insurance/public; Group 2: private) and by SES into three tiers based on census reported median household income for that zip code. Independent t-tests were used for insurance comparisons, and one-way ANOVA was applied for SES-based analyses. Additionally, variables such as body mass index (BMI), apnea-hypopnea index (AHI), Paradise criteria, Brodsky score, and distance from the surgical site were used to compare time to OR from referral. Age at time of surgery was also investigated alongside SES and insurance status.

Results: 1,200 charts were reviewed; 99 met inclusion criteria. The cohort was 47% male with an average age of 14.5 ±4.95 years. 99% of patients were insured, 86.7% of which were publicly insured while 13.3% had private insurance coverage. Socioeconomic status analysis revealed significant disparities regarding age at time of tonsillectomy, BMI, and distance from operative site. Patients with lower SES were older at time of surgery compared to higher SES counterparts (p=0.05), had a significantly higher BMI (p=0.000009), and traveled farther for their operation (p=0.03). Surgical timing metrics were not significant when compared with insurance coverage or SES. Age at the time of surgery, BMI, and distance to hospital were also not significant when associated with insurance status.

Conclusions: While insurance type did not impact access or demographic variables, SES was associated with increased age, BMI, and travel burden among lower SES patients. These findings underscore the need for targeted strategies to mitigate socioeconomic barriers in pediatric otolaryngologic.