(0236) Otolaryngology Care Disparities in American Indian Populations

Introduction: American Indian populations have long experienced large disparities in healthcare, including within the field of otolaryngology. We sought to quantify geographical disparities in otolaryngology care access with respect to American Indian populations.

Methods: A cross-sectional study was performed using US states with at least one American Indian (AI) area that either met the 65,000 population threshold for annual US Census Bureau American Community Survey (ACS) estimates or the 20,000 population threshold for ACS supplemental estimates. We elected to exclude Alaska Native (AN) populations, as all of Alaska’s geographic area is encompassed by AN areas with no non-AN areas that could be used as a comparison group. Population metrics of AI areas were obtained using data from the 2017-2021 ACS via the US Census Bureau “My Tribal Area” tool, while practice locations of otolaryngologists were retrieved using the American Academy of Otolaryngology–Head and Neck Surgery provider database. AI areas and provider locations were mapped using publicly available datasets via ArcGIS software. Availability of otolaryngologists was expressed as the number of providers per 100,000 residents for both AI areas and non-AI areas, and a two-tailed t-test was performed.

Results: The mean number of otolaryngologists per 100,000 individuals in AI areas was significantly lower than the mean in non-AI areas (0.409 vs 2.233, p < 0.001). Of the 15 selected states, 11 did not have any ENT providers within their respective AI areas. Furthermore, the average number of otolaryngologists per 100,000 individuals in non-AI areas (mean 2.07) is nearly one standard deviation lower than the nationwide mean (mean 2.66, SD 0.66).

Conclusions: These results support our hypothesis that the geographic distribution of ENT care within AI areas is lower than in non-AI areas, and support statements from previous studies hypothesizing that geographic access to ENT care may contribute to AI care disparities. We hope this study will inform further research regarding geographic accessibility to otolaryngologic care for AI populations.