Geographic and racial/ethnic patterns of polysomnography use among children enrolled in Medicaid, 2017–2019

PURPOSE: The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019. METHODS: The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Bureau Division, state and local levels. Geographic patterns were visualized with maps and plots. PSG rates were modeled by Rural-Urban Commuting Area (RUCA) classification and race-ethnicity composition at the ZIP code level. Data quality concerns resulted in exclusion of Rhode Island and Vermont. RESULTS: There were 478,568 PSGs identified among eligible children in the claims data, resulting in a national rate of 50.1 PSGs per 10,000 Medicaid enrolled children per year. There was a fourfold difference in rates at the state level, ranging from 23 PSGs per 10,000 person-years (Kansas) to 93 per 10,000 (Michigan). New England and the Great Lakes regions had the highest local levels, while the Pacific and West South Central divisions had the lowest. ZIP codes with higher percent White population (> 90%) and those in metropolitan areas had the highest PSG rates. CONCLUSION: This descriptive study of pediatric PSG utilization in the USA can inform efforts to provide more equitable access to PSG and refinement of practice guidelines for referral to PSG. CURRENT KNOWLEDGE/STUDY RATIONALE: Polysomnography provides a definitive diagnosis for obstructive sleep apnea and other sleep problems. Although there are concerns about variation in access, the utilization patterns of pediatric polysomnography in the USA is unknown. STUDY IMPACT: At the state level, polysomnography among children enrolled in Medicaid exhibited a fourfold difference in rates. ZIP codes in metropolitan areas and those with a high proportion of White non-Hispanic population had the highest utilization rates. These data can inform consensus among professional groups and healthcare policy researchers to improve equitable utilization.