(0204) American Indian, Black, and Hispanic Patients Face Potential Barriers to Otolaryngologists Compared to Medicare Population

Introduction: Barriers to care for certain underserved populations have been a focus of study. To identify potential barriers, this study analyzed differences between otolaryngology (ORL) and family practice (FP) Medicare patient demographics.

Methods: This cross-sectional study was conducted in January 2024. The Medicare Physician & Other Practitioners by Provider dataset for 2021 was filtered by otolaryngology and family practice, and only MD or DO equivalent credentials were included. Physicians with patient race/ethnicity counts summing to ≥100 were analyzed, and blank race/ethnicity counts due to Medicare patient privacy were imputed with a zero value. FP patients were assumed to represent the general Medicare population. An α of 0.05 was used for significance. Patient characteristics were pulled for age, gender, race/ethnicity, and Medicaid dual enrollment. Characteristics were then compared using the unequal variances, 2-tailed t-test between FP and ORL. Effect sizes using Hedges’ correction and 95% confidence intervals (CI) were also reported.

Results: In total, 46,161 FP and 6,614 ORL were analyzed, and all characteristics were significantly different (p < 0.001). ORL patients were older (mean: 73.8 vs 72.8 [CI: 0.9 to 1]; effect size: 0.34) and had a higher proportion of males (43.9 vs 42.4% [1.3 to 1.7%]; 0.15). ORL had a higher proportion of White (82.4 vs 79.9% [2.2 to 3%]; 0.13), Asian Pacific Islanders (1.9 vs 1.5% [0.2 to 0.6%]; 0.06), and Other Race (1.5 vs 0.8% [0.7 to 0.8%]; 0.33). ORL had a lower proportion of American Indian (0.1 vs 0.5% [-0.4 to -0.3%]; -0.07), Black (4.8 vs 5.5% [-0.9 to -0.5%]; -0.06), and Hispanic (3.4 vs 4.0% [-0.8 to -0.3%]; -0.05). Lastly, ORL had a lower proportion dual enrolled in Medicaid (13.6 vs 18% [-4.7 to -4.1%]; -0.27).

Conclusions: American Indian, Black, Hispanic, and dual-enrolled Medicare patients appear to face barriers to ORL services compared to the general Medicare population. Also, ORL cares for older, proportionally male, White, Asian Pacific Islander, and other race patients. Clarifying the cause of these barriers is crucial to enhance access for these populations.