Retropharyngeal (RPA) and parapharyngeal abscesses (PPA) are two of the most common deep neck infections (DNI). RPAs result from infections in the potential space between the pharyngeal constrictor and posterior vertebral fascia while parapharyngeal abscesses are often a result from direct extension of infection through the pharyngeal wall [[1], [2], [3]]. While these infections are relatively rare, approximately 0.22 cases 4 per 10,000 diagnosed yearly, they still pose a large risk to children [4]. Even more worrisome, studies indicate an increasing incidence over the past decade [[4], [5], [6]]. They most commonly present in children less than five years old, following respiratory tract infections that spread to the retropharyngeal and parapharyngeal lymph nodes [7]. These infections are typically limited to young children since these lymph nodes recede by age five [7,8]. RPAs and PPAs present similarly with symptoms including dysphagia, neck stiffness, fever, odynophagia, and respiratory distress [9]. DNis are dangerous due to their proximity and communication with the posterior mediastinum as well as cervical vessels [1,10]. This can lead to complications such as airway compromise, sepsis, necrotizing mediastinitis, carotid artery aneurysm, and occlusion of cervical vessels [ 11]. While there is debate regarding the standard of care, inpatient hospitalization is required for IV antibiotics and often surgical drainage [12].

Due to the severity of DNIs and potential life-threatening complications, it is imperative to assess barriers to identification and treatment. One important aspect that is often overlooked is how social determinants of health affect diagnosis. The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work and age, shaped by distribution of money, power, and resources.” [13] Race can also be an important social determinant of health as traditionally marginalized community members face disproportionate structural and institutional inequities leading to poorer health outcomes [14].

Disparities in health outcomes have been described for a number of pediatric conditions ranging from childhood obesity to asthma, and appendicitis [[15], [16], [17]]. Health inequities in Otolaryngology have been less extensively studied; however, there is evidence that social determinants have a large impact on otolaryngologic outcomes as well [18,19]. Children of color were noted to have a delay in treatment of sensorineural hearing loss (SNHL) compared to their Non-Hispanic White children [18]. These racial differences were also seen in rates of complications among children diagnosed with cholesteatomas [19].

This study uses the 2016 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) to study demographic variation in those diagnosed with RPA and PPAs. The HCUP KID publishes weighted pediatric inpatient discharges with important geographic, insurance, and demographic data from hospitals across the United States. The large size of the database is optimal for studying rare diseases like RPA and PPAs.