Disparities in utilization of outpatient surgical care among children

Infographic · Mar 2022 · 1 min read

In brief

This retrospective study of over 10,000 pediatric surgery patients found that neighborhood socioeconomic disadvantage, Black race, and public insurance were independently associated with 3-fold increased odds of clinic no-shows. Similar disparities persisted in postoperative follow-up visits, suggesting systemic barriers to outpatient surgical care access among disadvantaged children.

16% of pediatric surgery patients missed at least one clinic appointment, with 20% no-show rate for postoperative visits after common procedures.
Children from the most socioeconomically deprived neighborhoods had 3x higher odds of missing appointments compared to least deprived areas.
Black race (OR 3.30) and public insurance (OR 2.75) were independently associated with increased clinic no-shows after adjusting for other factors.
Disparities in outpatient access may contribute to worse surgical outcomes among disadvantaged children through missed postoperative care.
Neighborhood-level socioeconomic disadvantage (Area Deprivation Index) is a significant barrier to pediatric surgical follow-up care.

Written by the GCMD Library team from the infographic.

The infographic uses a red and navy blue color scheme with gray iconography. At the top is a bold red header, followed by study metadata in a red banner. The center features a circular donut chart showing the 16% no-show rate. Below are three columns with icons and odds ratios: a crossed-out dollar sign for socioeconomic status, a government building with medical symbol for insurance, and silhouettes of people for race. A vertical sidebar on the left shows parent-child figures and study population details.

Background: The purpose of this study was to quantify disparities in the utilization of outpatient pediatric surgical care and to examine the extent to which neighborhood-level socioeconomic disadvantage is associated with access to care among children.

Methods: Clinic "no-shows" were examined among children scheduled from 2017 to 2019 at seven pediatric surgery clinics associated with a tertiary care children's hospital. The association between Area Deprivation Index, a neighborhood-level measure of socioeconomic disadvantage, and other patient factors with clinic no-shows was examined using multivariable logistic regression models. Difficulties in accessing postoperative care in particular were explored in a subgroup analysis of postoperative (within 90 days) clinic visits after appendectomy or inguinal/umbilical hernia repairs.

Results: Among 10,162 patients, 16% had at least 1 no-show for a clinic appointment. Area Deprivation Index (most deprived decile adjusted odds ratio 3.17, 95% confidence interval 2.20-4.58, P < .001), Black race (adjusted odds ratio 3.30, 95% confidence interval 2.70-4.00, P < .001), and public insurance (adjusted odds ratio 2.75, 95% confidence interval 2.38-3.31, P < .001) were associated with having at least 1 no-show. Similar associations were identified among 2,399 children scheduled for postoperative clinic visits after undergoing appendectomy or inguinal/umbilical hernia repair, among whom 20% were a no-show.

Conclusion: Race, insurance type, and neighborhood-level socioeconomic disadvantage are associated with disparities in utilization of outpatient pediatric surgical care. Challenges accessing routine outpatient care among disadvantaged children may be one mechanism through which disparate outcomes result among children requiring surgical care.

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