Children from Lower Socioeconomic Backgrounds More Likely to Present with Most Severe Complications of ABS

What characteristics and disparities are associated with pediatric acute bacterial sinusitis (ABS) complications?

Background: ABS is common in the pediatric population, accounting for close to 1 million ambulatory visits annually. Because of the substantial morbidity and mortality associated with ABS complications, hospital admission is typically required for medical and surgical management. An examination of ABS presentation to emergency departments allows for a representative assessment of the demographic and socioeconomic characteristics of these children.

Study design: Cross-sectional study.

Setting: 2008 Nationwide Emergency Department Sample database.

Synopsis: The study included 101,660 children aged 18 years or younger diagnosed with ABS, 696 of whom had orbital or intracranial complications. Children with ABS complications were categorized as having 1) preseptal cellulitis (15% percent of patients; complication not associated with age or patients’ income levels), 2) orbital complications (76% of patients; complication associated with younger age and the highest income groups, and negatively associated with Medicaid), and 3) intracranial complications (9% of patients; complication associated with older age and lower socioeconomic status). A CRS diagnosis was associated with an increased likelihood of ABS complications, but HIV, lymphoma, leukemia, cystic fibrosis, and immune-system disorders were not. The two measures of socioeconomic status—primary payer and estimated median household income—were both significantly associated with an ABS complication. Children from the highest income groups were most likely to present with an ABS complication compared with those from the lowest income groups. Patients with “other” types of governmental insurance were more likely to present with complicated ABS than patients with private insurance, Medicaid, or no insurance. Limitations included a lack of direct reporting on family income level and demographic characteristics such as race, and broad descriptions of emergency departments.

Bottom line: Although increasing income level was positively associated with increasing severity of ABS complications, children from lower socioeconomic backgrounds were more likely to present with intracranial complications—the most severe complications—of ABS.

Citation: Sedaghat AR, Wilke CO, Cunningham MJ, Ishman SL. Socioeconomic disparities in the presentation of acute bacterial sinusitis complications in children. Laryngoscope. 2014;124:1700-1706.