Effects of social determinants of health in pediatric sleep-disordered breathing and allergic rhinitis management

OBJECTIVE: To evaluate the impact of social determinants of health (SDoH) on clinical characteristics and surgical outcomes in pediatric patients with sleep-disordered breathing (SDB) and allergic rhinitis (AR) undergoing adenotonsillectomy (T&A) with or without inferior turbinate reduction (ITR). STUDY DESIGN: Retrospective cohort study. SETTING: UPMC Children's Hospital of Pittsburgh. METHODS: Pediatric patients with SDB and AR who underwent T&A with or without ITR from 2007 to 2017 were included. SDoH variables were race, insurance status, sex, and neighborhood-level measures such as Area Deprivation Index (ADI), Child Opportunity Index (COI), distance to hospital, and environmental pollutant exposure. Statistical analysis was performed using logistic regression, Spearman's rank correlation, and Wilcoxon rank-sum tests (α = 0.05). RESULTS: Asthma (41.4% vs 15.7%, p = 0.003) and eye symptoms (10.3% vs 0.9%, p = 0.03) were more common in non-White patients. Patients with allergic dermatitis lived in less deprived neighborhoods (median 23.5 vs 72, p = 0.02). Public insurance was associated with persistent AR symptoms (OR: 2.69, p = 0.02) and post-operative sneezing (OR: 6.66, p = 0.02). Greater distance to hospital correlated with younger age at surgery and higher post-operative apnea-hypopnea index (AHI). Increased industrial pollution was associated with reduced adenoid obstruction. Females had lower pre-operative AHI and higher oxygen nadir. CONCLUSIONS: Socioeconomic, environmental, and demographic factors significantly influence disease characteristics and outcomes in pediatric SDB and AR. Addressing these factors is necessary for promoting health equity in pediatric otolaryngologic care.