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Race, Ethnicity, and Intensive Care Utilization for Common Pediatric Diagnoses: U.S. Pediatric Health Information
Katherine N Slain1,2, Matt Hall3, Manzilat Akande4
1Department of Pediatrics, Division of Pediatric Critical Care, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
Insights
Racial and ethnic disparities exist in pediatric critical care. Black, Hispanic, Asian, and other children show higher rates of Pediatric Intensive Care Unit (PICU) admission and longer hospital stays compared to White children.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Health equity
Background:
- Racial and ethnic disparities in healthcare for acutely ill children are well-documented in the U.S.
- However, it remains unclear if these disparities extend to the utilization of critical care services.
Purpose of the Study:
- To investigate potential racial and ethnic differences in the utilization of Pediatric Intensive Care Unit (PICU) services among acutely ill children.
- To examine disparities in PICU admission rates and hospital length of stay (LOS) based on race and ethnicity.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System (PHIS) database, a multicenter database from academic children's hospitals in the U.S.
- Included children discharged in 2019 with conditions frequently requiring PICU care (≥5% hospitalization rate).
- Compared PICU admission rates and total hospital LOS across racial and ethnic groups, adjusting for demographics and illness severity.
Main Results:
- One-quarter of hospitalizations involved a PICU admission.
- Black children had higher odds of PICU admission for bronchiolitis, respiratory failure, seizure, and diabetic ketoacidosis (DKA).
- Hispanic, Asian, and other race children also had higher PICU admission odds in several diagnostic categories compared to White children. Children from minority racial/ethnic groups experienced longer hospital LOS for respiratory failure, pneumonia, DKA, and sepsis after adjustments.
Conclusions:
- Findings suggest potential inequities in the utilization of critical care services for acutely ill children.
- Further research is essential to understand and eliminate racial and ethnic disparities in PICU utilization.
Objectives:
Racial and ethnic disparities in healthcare delivery for acutely ill children are pervasive in the United States; it is unknown whether differential critical care utilization exists.
Design:
Retrospective study of the Pediatric Health Information System (PHIS) database.
Setting:
Multicenter database of academic children's hospitals in the United States.
Patients:
Children discharged from a PHIS hospital in 2019 with one of the top ten medical conditions where PICU utilization was present in greater than or equal to 5% of hospitalizations.
Interventions:
None.
Measurements And Main Results:
Race and ethnicity categories included Asian, Black, Hispanic, White, and other. Primary outcomes of interest were differences in rate of PICU admission, and for children requiring PICU care, total hospital length of stay (LOS). One-quarter ( n = 44,200) of the 178,134 hospital discharges included a PICU admission. In adjusted models, Black children had greater adjusted odds ratio (aOR [95% CI]) of PICU admission in bronchiolitis (aOR, 1.08 [95% CI, 1.02-1.14]; p = 0.01), respiratory failure (aOR, 1.18 [95% CI, 1.10-1.28]; p < 0.001), seizure (aOR, 1.28 [95% CI, 1.08-1.51]; p = 0.004), and diabetic ketoacidosis (DKA) (aOR, 1.18 [95% CI, 1.05-1.32]; p = 0.006). Together, Hispanic, Asian, and other race children had greater aOR of PICU admission in five of the diagnostic categories, compared with White children. The geometric mean (± sd ) hospital LOS ranged from 47.7 hours (± 2.1 hr) in croup to 206.6 hours (± 2.8 hr) in sepsis. After adjusting for demographics and illness severity, children from families of color had longer LOS in respiratory failure, pneumonia, DKA, and sepsis.
Conclusions:
The need for critical care to treat acute illness in children may be inequitable. Additional studies are needed to understand and eradicate differences in PICU utilization based on race and ethnicity.
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