Geographic Disparities in Treatment of Recurrent Respiratory Papillomatosis (RRP): A Clinical Chart Review of Pediatric Cases in Panama from 2003-2013

Background: RRP, a rare disease caused by infection with Human Papiloma Virus (HPV), often requires repeated surgeries at specialized referral centers. RRP is believed to be transmitted vertically when an infant passes through a birth canal infected with HPV. In Panama, a country with high HPV prevalence, there are no recent studies reviewing trends in treatment of RRP.

Methods: Clinical chart review of RRP cases seen at the only 2 pediatric referral centers in Panama from 2003-2013. Variables of interest included place of residence, time between first symptom and diagnosis, and number of documented surgeries.

Results: A total of 20 cases were reviewed. Average time between first symptom and diagnosis was 2.0 years (n=8, SD=1.7) and 1.0 years (n=5, SD=.9) among patients living in the province of Panama versus distant provinces, respectively. Patients living in the province of Panama were 12.5 times more likely to have undergone at least 5 surgeries when compared to patients living in distant provinces (CI 1.1-143.4; p<0.05).

Discussion: Among our sample, there did not appear to be a delay in diagnosis when comparing patients based on their province of origin. When patients living in and around the capital city versus distant provinces were compared, urban patients were more likely to have undergone >5 surgical procedures, suggesting that treatment patterns are geographically dependent. More research is necessary to determine whether this demonstrates decreased access to and utilization of surgical services based on geography, or if cases in urban communities are more severe, requiring more aggressive treatment.