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Racial/Ethnic Variation in Emergency Department Care for Children With Asthma
Heather G Zook, Nathaniel R Payne, Susan E Puumala
1Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
Insights
Pediatric asthma patients from racial/ethnic minority groups received steroids more often and had fewer radiology tests than white children. These disparities in emergency department care may stem from complex factors like disease severity and access to healthcare.
Area of Science:
- Pediatric Emergency Medicine
- Health Disparities Research
- Asthma Management
Background:
- Emergency department (ED) visits for pediatric asthma are common.
- Racial and ethnic disparities in healthcare delivery are a significant concern.
- Understanding variations in ED asthma treatment across different patient groups is crucial for equitable care.
Purpose of the Study:
- To investigate differences in emergency department (ED) asthma treatment for pediatric patients across various racial and ethnic groups.
- To identify potential disparities in the administration of key asthma medications and diagnostic procedures.
Main Methods:
- A cross-sectional analysis of pediatric asthma visits (ages 2-18) was conducted across six emergency departments.
- Mixed-effects logistic regression models were used to analyze the odds of receiving steroids, radiology tests, and 30-day ED revisits.
- A subgroup analysis focused on patients who received albuterol treatment in the ED.
Main Results:
- After adjusting for covariates, African American and Hispanic children had higher odds of receiving steroids compared to white children.
- African American children had lower odds of undergoing radiological testing compared to white children.
- Asian children had significantly lower odds of 30-day ED revisits; American Indian children showed lower odds of radiological testing in a subgroup analysis.
Conclusions:
- Pediatric patients from racial/ethnic minority groups experienced disparities in ED asthma care, including increased steroid use and decreased radiological testing.
- The observed differences are likely multifactorial, potentially related to variations in disease severity, health literacy, and healthcare access.
- Further research is needed to elucidate the specific drivers of these disparities and to develop targeted interventions.
Objective:
To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients.
Methods:
This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED.
Results:
The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01).
Conclusions:
In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.
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