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Racial/ethnic differences in the presentation and management of severe bronchiolitis
Jonathan Santiago1, Jonathan M Mansbach, Shih-Chuan Chou
1Yale, School of Medicine, New Haven, Connecticut.
Insights
Racial and ethnic disparities exist in severe bronchiolitis care. Non-Hispanic Black children received more albuterol pre-admission, while Hispanic children were more likely to be discharged on inhaled corticosteroids, deviating from guidelines.
Area of Science:
- Pediatric respiratory illnesses
- Health services research
- Health equity
Background:
- Bronchiolitis is a leading cause of infant hospitalization in the US.
- It is linked to an increased risk of childhood asthma.
- Existing research shows racial/ethnic disparities in asthma care, but less is known about bronchiolitis.
Purpose of the Study:
- To investigate racial and ethnic differences in the presentation and management of severe bronchiolitis.
- To identify disparities in diagnostic imaging and treatment for hospitalized infants with bronchiolitis.
Main Methods:
- A prospective cohort study involving 2130 infants <2 years old across 16 centers (2007-2010).
- Data collected via structured interviews, chart reviews, and phone follow-up.
- Multivariable logistic regression analyzed associations between race/ethnicity and care practices.
Main Results:
- Non-Hispanic Black (NHB) children were more likely to receive albuterol before admission (OR: 1.58) and less likely to receive chest x-rays (OR: 0.66).
- Hispanic children were more likely to be discharged on inhaled corticosteroids (OR: 1.92).
- Observed disparities in pre-admission albuterol use, imaging, and discharge medications compared to non-Hispanic white (NHW) children.
Conclusions:
- Significant racial/ethnic differences were found in severe bronchiolitis management.
- These practices, including albuterol use, imaging, and inhaled corticosteroid prescriptions, deviate from American Academy of Pediatrics guidelines.
- Further research into the causes of these disparities is needed, supporting the implementation of standardized care pathways.
Background And Objective:
Bronchiolitis is the leading cause of hospitalization for US infants and is associated with increased risk of childhood asthma. Although studies have shown differences in the presentation and management of asthma across race/ethnicity, it is unclear if such differences are present for bronchiolitis. We examined if racial/ethnic differences exist in the presentation and management of severe bronchiolitis.
Methods:
We performed a 16-center, prospective cohort study from 2007 to 2010. Children <2 years old hospitalized with a diagnosis of bronchiolitis were included. A structured interview, chart review, and 1-week phone follow-up were completed. Multivariable logistic regression was used to examine the independent association between race/ethnicity and diagnostic imaging, treatment (eg, albuterol, corticosteroids, and continuous positive airway pressure/intubation), management (eg, intensive care unit admission and length of stay), discharge on inhaled corticosteroids, and bronchiolitis relapse.
Results:
Among 2130 patients, 818 (38%) were non-Hispanic white (NHW), 511 (24%) were non-Hispanic black (NHB), and 801 (38%) were Hispanic. Compared with all groups, NHB children were most likely to receive albuterol before admission (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.20-2.07) and least likely to receive chest x-rays during hospitalization (OR: 0.66; 95% CI: 0.49-0.90). Hispanic children were most likely to be discharged on inhaled corticosteroids (OR: 1.92; 95% CI: 1.19-3.10).
Conclusion:
We observed differences between NHW and minority children regarding preadmission albuterol use, inpatient diagnostic imaging, and prescription of inhaled corticosteroids at discharge, practices that deviate from the American Academy of Pediatrics guidelines. The causes of these differences require further study, but they support implementation of care pathways for severe bronchiolitis.
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