The association between race, ethnicity and presentation to a pediatric capable hospital

Pediatric readiness is associated with improved quality of care and has known geographic variation. Less is known about disparities in patient access to hospital pediatric capabilities. Our goal was to examine associations between patient race / ethnicity and pediatric capability of the initial hospital presentation.

We linked state data, combining 2019 National Emergency Department Inventory (NEDI)-USA, 2019 State Emergency Department and State Inpatient Databases (SEDD/SID), 2020 Supplemental NEDI Pediatric Emergency Care Coordinator (PECC) Survey, and the 2021 National Pediatric Readiness Program (NPRP) Survey. Primary exposure was race / ethnicity. We compared pediatric capability definitions and used logistic regressions to examine associations between race / ethnicity and pediatric capability adjusting for select covariates.

There were 2,281,885 ED visits in the NPRP cohort, 4,426,520 in the PECC cohort and 4,964,956 in the inpatient capability cohort. In unadjusted analyses, non-Hispanic Black and Hispanic patients had higher odds of presenting to hospitals with high NPRP scores (OR 2.02 [95% CI 1.44, 2.84] and OR 1.94 [95% CI 1.09, 3.46]), with a PECC (OR 2.30 [1.83, 2.88] and OR 3.14 [2.32, 4.26]), and with inpatient capability (2.03 [1.64, 2.51] and 2.08 [1.54, 2.81]). After adjustment, non-Hispanic Black patients had higher odds of presenting to hospitals with inpatient capability (1.47 [1.13-1.92]); in contrast Hispanic patients had higher odds of presenting to hospitals with a PECC (1.48 [1.11-1.98]).

Non-Hispanic Black and Hispanic children were more likely to present to a hospital with a PECC, suggesting utilization of PECCs may reduce disparities in care.