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Published on: August 30, 2018
Patterns of inpatient antibiotic utilization by race and ethnicity at US children's hospitals
Bethany A Wattles1, Jeffrey I Campbell2, Theresa Kluthe3
1Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
Insights
Inpatient antibiotic use in children varies by race and ethnicity. Non-Hispanic Black children had lower odds of receiving antibiotics, while Native Hawaiian/Other Pacific Islander children had higher odds, indicating potential disparities in pediatric care.
Area of Science:
- Pediatric hospital medicine
- Health services research
- Pharmacoeconomics
Background:
- Racial and ethnic disparities in outpatient antibiotic use are documented.
- Limited data exists on inpatient antibiotic utilization across diverse pediatric populations.
Purpose of the Study:
- To analyze national inpatient antibiotic utilization among children.
- To compare antibiotic use by race and ethnicity in pediatric hospital settings.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) database from 2022.
- Included 846,530 hospitalizations for patients under 20 years old.
- Analyzed antibiotic encounters and days of therapy (DOT) using mixed-effect regression models, adjusting for covariates.
Main Results:
- Non-Hispanic (NH) White children comprised 45.2% of hospitalizations.
- NH Black children had lower odds of receiving antibiotics (aOR 0.96) compared to NH White children.
- NH Native Hawaiian/Other Pacific Islander (NHPI) children had higher odds (aOR 1.16) and more DOT of antibiotics.
Conclusions:
- Significant racial and ethnic variations in pediatric inpatient antibiotic utilization exist.
- Hospitals must evaluate practices contributing to treatment disparities.
- Antibiotic stewardship programs are crucial for promoting inpatient pharmacoequity in pediatric care.
Background And Objectives:
Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.
Methods:
This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.
Results:
There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94-0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05-1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.
Conclusions:
Antibiotic utilization in children's hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.
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