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Abstract
Objective To provide new evidence on how tonsils surgery in children has geographically varied over time in the context of the Spanish National Health System.
Design Observational ecological spatiotemporal study on geographical variations in medical practice, using linked administrative datasets, including virtually all surgeries performed from 2003 to 2015.
Setting The Spanish National Health System, a quasi-federal structure with 17 autonomous communities (ACs), and 203 healthcare areas (HCAs).
Participants Patients aged 19 and younger residing in the HCAs and ACs.
Interventions Tonsillectomy with adenoidectomy (T&A); and tonsillectomies alone (T).
Main endpoints (1) Evolution of T&A and T rates; (2) spatiotemporal variation in the risk of receiving T&A or T surgery at regional level (ACs) and HCAs; and (3) the fraction of the variation (FV) attributed to each of the components of variation—ACs, HCAs, year and interaction ACs year.
Results T&A age-sex standardised rates increased over the period of analysis from 15.2 to 20.9 (5.7 points per 10 000 inhabitants). T alone remained relatively lower than T&A rates, evolving from 3.6 in 2003 to 3.9 in 2015 (0.3 points per 10 000 inhabitants). Most of the risk variation was captured at the HCAs level in both procedures (FV: 55.3% in T&A and 72.5% in T). The ACs level explained 27.6% of the FV in the risk in T&A versus 8% in T. The interaction ACs year was similar in both procedures (FV: 15.5% in T&A and 17.5% in T). The average trend hardly explained 1.46% and 1.83% of the variation, respectively.
Conclusion Our study showed wide persistent variations with a steady increase in rates and risk of T&A and a stagnation of T alone, where most of the variation risk was explained at HCA level.
- Paediatric otolaryngology
- Health policy
- Health economics
Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party under request and are not publicly available.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party under request and are not publicly available.
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Footnotes
Twitter @VoroPeiro
Contributors All authors contributed to conceptualising and designing the study. NM-L prepare the final dataset. JL and MC-M run the statistical analysis. MR, JL, MC-M, EA-P and SP commented on important intellectual content and made revisions. EC-R, MR and EB-D drafted the manuscript. All authors read and approved the final version of the manuscript. EC-R, MR and EB-D accept full responsibility
for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding MR and EAP are partially funded by the Spanish Health Services Research on Chronic Patients Network (REDISSEC) - Institute of Health Carlos III. Grant number: RD16/0001/0007. There is also a non-conditional additional public contribution from the Institute of Health Carlos III. Grant number RD21/0016/0023.
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Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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