A recent study published in the Journal of Clinical Sleep Medicine reveals significant disparities in access to sleep tests for children enrolled in Medicaid across the United States. Researchers found that the likelihood of receiving polysomnography—the standard overnight sleep study used to diagnose obstructive sleep apnea—varies dramatically by geographic location and the racial composition of neighborhoods.
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Led by Colleen C. McLaughlin of Nationwide Children’s Hospital in Ohio, the analysis utilized data from the Transformed Medicaid Statistical Information System, examining claims from 2017 to 2019. The study included over 51.7 million children, identifying a total of 482,688 polysomnography tests. After refining the data, 478,568 tests were used for the final state-level analysis, indicating a national utilization rate of 50.1 tests per 10,000 Medicaid-enrolled children per year.
However, the results showed stark local variations. Rates ranged from just 23 tests per 10,000 in Kansas to 93 per 10,000 in Michigan. In particular, the East North Central Census Division, anchored by Michigan, had the highest average rate at 64.9 per 10,000. In contrast, the Pacific and West South Central divisions recorded much lower rates, with Texas exhibiting some of the lowest figures.
The analysis also highlighted two significant demographic trends: urban areas showed higher testing rates, while neighborhoods predominantly inhabited by residents of color experienced lower rates of polysomnography. Specifically, areas with over 90% White non-Hispanic residents had a testing rate of 50.8 per 10,000, compared to just 27.6 per 10,000 in more diverse neighborhoods. This suggests a systemic issue where children in racially diverse areas face barriers to receiving necessary tests.
The researchers underscored the importance of understanding these geographic and demographic disparities, as they could inform guidelines for sleep disorder evaluations in children. They noted that some professional organizations have differing recommendations regarding when a sleep study is required, adding to the complexity of access to care.
The findings serve as a crucial baseline for addressing issues of equity in pediatric healthcare, emphasizing the need to identify and mitigate barriers that prevent disadvantaged children from receiving proper sleep assessments. The authors call for further investigation into the availability of pediatric sleep laboratories and the structural challenges that affect testing accessibility, stressing that equitable diagnosis and treatment for sleep disorders must be prioritized across all communities.