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Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals
Aubree C Honcoop1, Patricia Poitevien2, Ellen Kerns3
1University of Nebraska Medical Center, Omaha, Nebraska, USA.
Insights
Black and Hispanic children with bronchiolitis receive different care than White children, with Black children more likely to receive asthma medications and Hispanic children less likely to receive diagnostic tests or antibiotics. Further investigation into these disparities is needed.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Equity
Background:
- Bronchiolitis management varies by race and ethnicity, but large-scale data across emergency departments (EDs) and inpatient settings are limited.
- Previous studies have shown disparities in single centers, necessitating broader assessments.
Purpose of the Study:
- To examine the association between race/ethnicity and the management of bronchiolitis in children across multiple U.S. children's hospitals.
- To identify differences in diagnostic testing and therapeutic interventions based on patient race and ethnicity.
Main Methods:
- Analysis of the Pediatric Health Information System database for children aged 3-24 months diagnosed with bronchiolitis from November 2015 to November 2018.
- Comparison of management strategies (diagnostic tests, medications) across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic children using mixed-effect logistic regression.
- Subanalyses for ED patients and children under 1 year old were conducted.
Main Results:
- Non-Hispanic Black (NHB) children had higher odds of receiving asthma-associated medications (OR=1.27) and lower odds of receiving diagnostic tests (OR=0.78) and antibiotics (OR=0.58) compared to NHW children.
- Hispanic children had lower odds of receiving diagnostic testing (OR=0.94), asthma-associated medication (OR=0.92), and antibiotics (OR=0.74) compared to NHW children.
- NHB children more frequently received corticosteroid and bronchodilator therapies, while NHW children more frequently received antibiotics and chest radiography.
Conclusions:
- Significant racial and ethnic disparities exist in bronchiolitis management, including differing patterns of overtreatment.
- NHB children were more likely to receive certain therapies, while NHW children were more likely to receive others, deviating from recommended supportive care.
- The underlying causes for these observed management differences require further investigation to promote equitable care.
Objective:
Variation in bronchiolitis management by race and ethnicity within emergency departments (EDs) has been described in single-center and prospective studies, but large-scale assessments across EDs and inpatient settings are lacking. Our objective is to describe the association between race and ethnicity and bronchiolitis management across 37 U.S. freestanding children's hospitals from 2015 to 2018.
Methods:
Using the Pediatric Health Information System, we analyzed ED and inpatient visits from November 2015 to November 2018 of children with bronchiolitis 3 to 24 months old. Rates of use for specific diagnostic tests and therapeutic measures were compared across the following race/ethnicity categories: 1) non-Hispanic White (NHW), 2) non-Hispanic Black (NHB), 3) Hispanic, and 4) other. The subanalyses of ED patients only and children < 1 year old were performed. Mixed-effect logistic regression was performed to compare the adjusted odds of receiving specific test/treatment using NHW children as the reference group.
Results:
A total of 134,487 patients met inclusion criteria (59% male, 28% NHB, 26% Hispanic). Adjusted analysis showed that NHB children had higher odds of receiving medication associated with asthma (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.22 to 1.32) and lower odds of receiving diagnostic tests (blood cultures, complete blood counts, viral testing, chest x-rays; OR = 0.78, 95% CI = 0.75 to 0.81) and antibiotics (OR = 0.58, 95% CI = 0.52 to 0.64) than NHW children. Hispanic children had lower odds of receiving diagnostic testing (OR = 0.94, 95% CI = 0.90 to 0.98), asthma-associated medication (OR = 0.92, 95% CI = 0.88 to 0.96), and antibiotics (OR = 0.74, 95% CI = 0.66 to 0.82) compared to NHW children.
Conclusion:
NHB children more often receive corticosteroid and bronchodilator therapies; NHW children more often receive antibiotics and chest radiography. Given that current guidelines generally recommend supportive care with limited diagnostic testing and medical intervention, these findings among NHB and NHW children represent differing patterns of overtreatment. The underlying causes of these patterns require further investigation.
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