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Racial Disparities in Health Care Resource Utilization After Pediatric Cervical and/or Thoracic Spinal Injuries
Aladine A Elsamadicy1, Mani R Sandhu1, Isaac G Freedman1
1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Race significantly impacts hospital length of stay for pediatric patients with spinal injuries. Non-Hispanic Black children experienced longer hospital stays, highlighting disparities in healthcare resource utilization.
Area of Science:
- Pediatric Traumatology
- Health Services Research
- Health Disparities
Background:
- Pediatric cervical/thoracic spinal injuries are serious, requiring extensive hospital care.
- Understanding racial disparities in healthcare outcomes is crucial for improving patient care.
Purpose of the Study:
- To investigate the impact of race on hospital length of stay (LOS) and complications in pediatric patients with cervical/thoracic injuries.
- To identify potential racial disparities in healthcare resource utilization for this patient population.
Main Methods:
- Retrospective cohort study using the 2017 National Trauma Data Bank.
- Inclusion of pediatric patients (n=4,125) with cervical/thoracic spine injuries.
- Analysis of demographic data, injury types, hospital LOS, and complication rates, stratified by race (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic).
Main Results:
- Non-Hispanic Black patients had a higher prevalence of cervical-only injuries and assault-related trauma.
- Overall complication rates were significantly higher in non-Hispanic Black patients.
- Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients experienced significantly longer hospital LOS compared to non-Hispanic White patients. Non-Hispanic Black race was a significant predictor of increased LOS.
Conclusions:
- Race is a significant factor influencing healthcare resource utilization in pediatric cervical/thoracic spinal trauma.
- Disparities in hospital length of stay exist among racial groups, warranting further investigation and targeted interventions.
Objective:
This study aimed to investigate the impact of race on hospital length of stay (LOS) and hospital complications among pediatric patients with cervical/thoracic injury.
Methods:
A retrospective cohort was performed using the 2017 admission year from 753 facilities utilizing the National Trauma Data Bank. All pediatric patients with cervical/thoracic spine injuries were identified using the ICD-10-CM diagnosis coding system. These patients were segregated by their race, non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian (NHA), and Hispanic (H). Demographic, hospital variable, hospital complications, and LOS data were collected. A linear and logistic multivariate regression analysis was performed to determine the risk ratio for hospital LOS as well as complication rate, respectively.
Results:
A total of 4,125 pediatric patients were identified. NHB cohort had a greater prevalence of cervical-only injuries (NHW: 37.39% vs. NHB: 49.93% vs. NHA: 34.29% vs. H: 38.71%, P < 0.001). While transport accident was most common injury etiology for both cohorts, NHB cohort had a greater prevalence of assault (NHW: 1.53% vs. NHB: 17.40% vs. NHA: 2.86% vs. H: 6.58%, P < 0.001) than the other cohorts. Overall complication rates were significantly higher among NHB patients (NHW: 9.39% vs. NHB: 15.12% vs. NHA: 14.29% vs. H: 13.60%, P < 0.001). Compared with the NHW cohort, NHB, NHA, and H had significantly longer hospital LOS (NHW: 6.15 ± 9.03 days vs. NHB: 9.24 ± 20.78 days vs. NHA: 9.09 ± 13.28 days vs. H: 8.05 ± 11.45 days, P < 0.001). NHB race was identified as a significant predictor of increased LOS on multivariate regression analysis (risk ratio: 1.14, 95% confidence interval: 0.46, 1.82; P = 0.001) but not hospital complications (P = 0.345).
Conclusions:
Race may significantly impact health care resource utilization following pediatric cervical/thoracic spinal trauma.
