Decreasing rates of middle ear surgery in Western Australian children.

Objective: To investigate temporal, social, demographic, and health care utilization factors associated with myringotomy with ventilation tube insertion (MVTI) in Western Australian (WA) children.

Design: Observational retrospective population-based cohort study using hospital administrative data.

Setting: All WA hospitals.

Participants: A total of 53 673 children younger than 15 years who underwent surgery for MVTI in the period 1981-2004.

Main Outcome Measures: Age-specific incidence rates and incidence rate ratios.

Results: The rate of MVTI in children younger than 15 years peaked in 1997 at 6.7 per 1000 person-years and decreased to 5.6 per 1000 person-years by 2004. Based on 2004 rates, 8.4% of WA children will undergo at least 1 MVTI procedure before reaching age 15 years. The rate of MVTI was 37% lower in Indigenous children, and the procedures were performed at an older age compared with non-Indigenous children. Higher rates of MVTI were associated with areas of higher economic resources, lower education and occupation status, and living in metropolitan areas.

Conclusions: The rate of MVTI in WA is showing evidence of a decline, even among children younger than 5 years. There remains an issue regarding equity of access to care for Indigenous children. Increasing parental economic resources may be associated with higher rates of MVTI independent of educational status.