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Leaving the emergency department without complete care: disparities in American Indian children
Tess L Weber1, Katherine M Ziegler2, Anupam B Kharbanda3
1Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.
Insights
American Indian children are more likely to leave the emergency department without complete care compared to White children. This study highlights disparities in pediatric emergency care access and outcomes for American Indian youth.
Area of Science:
- Pediatric Emergency Medicine
- Health Disparities Research
- Public Health Policy
Background:
- Children leaving the emergency department without complete evaluation or care (LWCET) experience poorer health outcomes.
- Previous research indicates higher LWCET rates among American Indian (AI) children compared to other racial/ethnic groups.
- Understanding these disparities is crucial for improving pediatric healthcare access.
Purpose of the Study:
- To examine the rates of LWCET in American Indian children.
- To explore differences in LWCET based on emergency department (ED) location and utilization patterns.
- To identify factors contributing to higher LWCET rates in AI children.
Main Methods:
- Retrospective cohort study of 68,461 pediatric ED visits (June 2011-May 2012) across five upper Midwest EDs.
- Inclusion criteria: children aged 0-17 identifying as African American, American Indian, or White.
- Logistic regression analysis controlled for covariates like sex, age, insurance, triage level, distance, and ED activity.
Main Results:
- The overall LWCET rate was 1.73%.
- American Indian children had significantly higher odds of LWCET compared to White children (OR=1.62, 95% CI=1.30-2.03).
- No significant difference in LWCET was found between African American and White children. Triage level, distance, visit timing, and ED activity were also significant factors.
Conclusions:
- American Indian children exhibit higher LWCET rates than White children, a disparity not observed with African American children.
- Complex, multifactorial reasons likely underlie these disparities in the upper Midwest.
- Further research is needed to explore and address the specific factors contributing to LWCET in AI children.
Background:
Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns.
Methods:
This is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0-17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level.
Results:
LWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30-2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level.
Conclusion:
Our results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration.
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