Abstract
OBJECTIVE: Australian First Nations children bear 8.5 times greater burden of early and recurrent ear and nasopharyngeal infections compared with non-Indigenous children. These disparities are compounded by structural inequities in access to healthcare. To better understand these patterns, we analysed the state-wide epidemiology of childhood myringotomy procedures in South Australia and conducted spatial analysis for its main metropolitan region-Adelaide-to examine the associations with socioeconomic status and distance to healthcare facilities. DESIGN AND SETTING: A cross-sectional, population-wide study. PARTICIPANTS: All persons who had myringotomy procedures performed between 2007 and 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual, age and sex-specific incidence was calculated at the local scale (Statistical Area level 2, SA2). We used admitted patient care data from SA Health, providing comprehensive coverage of otitis media procedures across the population, including First Nations. We applied negative binomial regression to assess associations with socioeconomic status and distance to healthcare facilities, accounting for count-based data and overdispersion. RESULTS: Myringotomy incidence among First Nations children ranged from 2.2 to 6.1 per 1000 child-years across SA2 regions, compared with 2.4 to 3.7 among non-indigenous children. For the whole population, overall annual incidence ranged from 2.7 to 4.2 for males and 2.0 to 2.9 for females, with higher incidence observed in several suburban areas of Adelaide. Myringotomy procedures were associated with socioeconomic status, with increased socioeconomic advantage associated with a 17% reduction in cases (relative risk 0.83, 95% CI 0.76 to 0.92) among First Nations children. Distance to healthcare facilities was associated with myringotomy for non-indigenous children but not for First Nations children. CONCLUSIONS: This study found a higher incidence of myringotomy procedures among First Nations children, particularly in later childhood. Socioeconomic disadvantage was a driver, while geographic proximity to healthcare had limited influence. Future initiatives may benefit by prioritising culturally informed, community-led strategies focused on early intervention, prevention and equitable service delivery.