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Racial and ethnic differences in pediatric surgery utilization in the United States: A nationally representative
Cornelius B Groenewald1, Helen H Lee2, Nathalia Jimenez1
1Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, United States.
Insights
Minority children have lower rates of ambulatory surgery compared to White children, even after accounting for socioeconomic and health factors. These disparities suggest systemic barriers in pediatric surgical care access.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Health Equity
Background:
- Access to surgical care is crucial for child health outcomes.
- Previous studies suggest disparities in healthcare access for minority populations.
- Understanding racial/ethnic differences in surgical utilization is essential for addressing inequities.
Purpose of the Study:
- To assess racial and ethnic differences in the utilization of surgical procedures among children in the United States.
- To examine surgical utilization patterns across different care settings (inpatient, emergency department, hospital outpatient, office).
Main Methods:
- Cross-sectional analysis of the nationally representative Medical Expenditure Panel Survey (MEPS) data from 2015-2018.
- Inclusion of U.S. children aged 0-17 years, with race/ethnicity as the primary variable of interest.
- Multivariate logistic regression models were used to analyze the association between race/ethnicity and surgical utilization, controlling for covariates like insurance status, geographic location, and health status.
Main Results:
- The study included 31,024 children, with an overall surgical rate of 4.8%.
- Minority children (non-Hispanic Black, Hispanic, non-Hispanic Asian) had significantly lower adjusted odds of undergoing ambulatory surgery (hospital outpatient or office-based) compared to non-Hispanic White children.
- No significant racial/ethnic differences were found in the rates of inpatient or emergency department surgical procedures.
Conclusions:
- Significant racial/ethnic disparities exist in pediatric ambulatory surgery utilization.
- These differences persist even after adjusting for socioeconomic and health-related factors, indicating potential systemic barriers.
- Addressing these systemic barriers is critical to ensure equitable access to pediatric surgical care for all children.
Objectives:
Children of minority background have reduced access to surgery. This study assessed for racial/ethnic differences in surgical utilization by location.
Materials And Methods:
We conducted a cross-sectional analysis of U.S. children (0-17 years of age) participating in the nationally representative Medical Expenditure Panel Survey (MEPS, 2015-2018). Race/ethnicity was the variable of interest. The primary outcome variables were prevalence rates of surgery defined by location of surgical procedure (inpatient, emergency department, hospital outpatient, and office). Covariates included contextual factors that may influence access to and need for healthcare services, including age, sex, insurance status, residential geographic status, usual source of care, and parental reports of child's physical and mental health. We employed multivariate logistic regression models to assess the relationship between outcomes and race/ethnicity.
Results:
The study population included 31,024 children with an overall surgical rate of 4.8%. Adjusted odds of surgery in an ambulatory location were lower for all racial/ethnic minority groups compared to non-Hispanic White counterparts (non-Hispanic Black aOR = 0.3, 95% CI: 0.2-0.5; Hispanic aOR = 0.4, 95% CI: 0.3-0.6; non-Hispanic Asian aOR = 0.2, 95% CI 0.0-0.5 for hospital outpatient surgery; for office-based setting, non-Hispanic Black aOR = 0.4, 95% CI 0.3-0.6; Hispanic aOR = 0.5, 95% CI: 0.4-0.7; non-Hispanic Asian aOR = 0.4; 95% CI 0.3-0.7). No racial/ethnic differences were observed for surgical procedures in inpatient or emergency department locations.
Conclusions:
Staggering differences exist in pediatric surgery utilization patterns by racial/ethnic background, even after adjusting for important contextual factors (income, insurance, health status). Our findings in a nationally representative dataset may suggest systemic barriers related to racial/ethnic background for the pediatric surgical population.
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