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Racial/ethnic differences in receipt of surgery among children in the United States
Ethan L Sanford1, Rasmi Nair2, Adam Alder3
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA; Department of Pediatric Critical Care, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas, USA; Outcomes Research Consortium, Cleveland, OH, USA.
Insights
Racial and ethnic minority children in the US, including African-American, Asian, and Latino children, have significantly lower odds of receiving surgery compared to White children. Latino children also face higher risks for emergent or urgent surgical needs.
Area of Science:
- Pediatric Surgery
- Health Disparities Research
- Public Health
Background:
- Racial and ethnic disparities in surgical utilization among children in the United States remain largely unexamined.
- This study addresses the critical gap in understanding potential inequities in surgical care for pediatric populations.
Purpose of the Study:
- To evaluate the association between race/ethnicity and the likelihood of undergoing surgery in children across the US.
- To test the hypothesis that minority children experience reduced surgical access compared to their White counterparts.
Main Methods:
- Analysis of cross-sectional data from 219,098 children (0-18 years) using the 1999-2018 National Health Interview Survey.
- Primary outcome: odds of surgery in the past 12 months, comparing non-Latino African-American, Asian, and Latino children to non-Latino White children, adjusted for covariates.
- Secondary analysis using the National Surgical Quality Improvement Program Pediatric Dataset to assess odds of emergent/urgent surgery by race/ethnicity.
Main Results:
- African-American (AOR, 0.54), Asian (AOR, 0.39), and Latino (AOR, 0.62) children demonstrated significantly lower adjusted odds of surgery compared to White children.
- A total of 10,644 (4.9%) of the analyzed children received surgery.
- Latino children exhibited increased odds of requiring emergent or urgent surgery (AOR, 1.71).
Conclusions:
- Significant racial/ethnic disparities exist in pediatric surgical utilization in the US, with minority children having lower odds of surgery.
- Latino children face a higher likelihood of needing emergent or urgent surgical interventions.
- These findings underscore potential healthcare access inequities that necessitate further investigation, monitoring, targeted interventions, and quality improvement initiatives.
Background:
It is unknown whether racial/ethnic disparities exist in surgical utilization for children. The aim, therefore, was to evaluate the odds of surgery among children in the US by race/ethnicity to test the hypothesis that minority children have less surgery.
Methods:
Cross-sectional data were analyzed on children 0-18 years old from the 1999 to 2018 National Health Interview Survey, a large, nationally representative survey. The primary outcome was odds of surgery in the prior 12 months for non Latino African-American, Asian, and Latino children, compared with non Latino White children, after adjustment for relevant covariates. The National Surgical Quality Improvement Program Pediatric Dataset was used to analyze the odds of emergent/urgent surgery by race/ethnicity.
Results:
Data for 219,098 children were analyzed, of whom 10,644 (4.9%) received surgery. After adjustment for relevant covariates, African-American (AOR, 0.54; 95% CI, 0.50-0.59), Asian (AOR, 0.39; 95% CI, 0.33-0.46), and Latino (AOR, 0.62; 95% CI, 0.57-0.67) children had lower odds of surgery than White children. Latino children were more likely to require emergent or urgent surgery (AOR, 1.71; 95% CI, 1.68-1.74).
Conclusions:
Latino, African-American, and Asian children have significantly lower adjusted odds of having surgery than White children in America, and Latino children were more likely to have emergent or urgent surgery. These racial/ethnic differences in surgery may reflect disparities in healthcare access which should be addressed through further research, ongoing monitoring, targeted interventions, and quality-improvement efforts.
Level Of Evidence:
II.
Type Of Study:
Prognosis study.
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