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Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States.
Front Pediatr. 2019; 7:525.FP

Abstract

Background:

There is an incomplete understanding of disparities in emergency care for children across racial and ethnic groups in the United States. In this project, we sought to investigate patterns in emergency care utilization, disposition, and resource use in children by race and ethnicity after adjusting for demographic, socioeconomic, and clinical factors.

Methods:

In this cross-sectional study of emergency department (ED) data from the nationally representative National Hospital Ambulatory Medical Survey (NHAMCS), we examined multiple dimensions of ED care and treatment from 2005 to 2016 among children in the United States. The main outcomes include ED disposition (hospital admission, ICU admission, and in hospital death), resources utilization (medical imaging use, blood tests, and procedure use) and patient ED waiting times and total length of ED stay. The main exposure variable is race/ethnicity, categorized as non-Hispanic white (white), non-Hispanic black (Black), Hispanic, Asian, and Other. Analyses were stratified by race/ethnicity and adjusted for demographic, socioeconomic, and clinical factors.

Results:

There were 78,471 pediatric (≤18 years old) ED encounters, providing a weighted sample of 333,169,620 ED visits eligible for analysis. Black and Hispanic pediatric patients were 8% less likely (aOR 0.92, 95% CI 0.91-0.92) and 14% less likely (aOR 0.86, CI 0.86-0.86), respectively, than whites to have their care needs classified as immediate/emergent. Blacks and Hispanics were also 28 and 3% less likely, respectively, than whites to be admitted to the hospital following an ED visit (aOR 0.72, CI 0.72-0.72; aOR 0.97, CI 0.97-0.97). Blacks and Hispanics also experienced significantly longer wait times and overall visits as compared to whites.

Conclusions:

Black and Hispanic children faced disparities in emergency care across multiple dimensions of emergency care when compared to non-Hispanic white children, while Asian children did not demonstrate such patterns. Further research is needed to understand the underlying causes and long-term health consequences of these divergent patterns of racial disparities in ED care within an increasingly racially diverse cohort of younger Americans.

Authors+Show Affiliations

Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States.Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States.Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States.Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States.Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States.Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31956644

Citation

Zhang, Xingyu, et al. "Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States." Frontiers in Pediatrics, vol. 7, 2019, p. 525.
Zhang X, Carabello M, Hill T, et al. Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Front Pediatr. 2019;7:525.
Zhang, X., Carabello, M., Hill, T., He, K., Friese, C. R., & Mahajan, P. (2019). Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Frontiers in Pediatrics, 7, 525. https://doi.org/10.3389/fped.2019.00525
Zhang X, et al. Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Front Pediatr. 2019;7:525. PubMed PMID: 31956644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. AU - Zhang,Xingyu, AU - Carabello,Maria, AU - Hill,Tyler, AU - He,Kevin, AU - Friese,Christopher R, AU - Mahajan,Prashant, Y1 - 2019/12/19/ PY - 2019/09/09/received PY - 2019/12/04/accepted PY - 2020/1/21/entrez PY - 2020/1/21/pubmed PY - 2020/1/21/medline KW - disparity KW - emergency department KW - pediatrics KW - racial/ethnic KW - trend SP - 525 EP - 525 JF - Frontiers in pediatrics JO - Front Pediatr VL - 7 N2 - Background: There is an incomplete understanding of disparities in emergency care for children across racial and ethnic groups in the United States. In this project, we sought to investigate patterns in emergency care utilization, disposition, and resource use in children by race and ethnicity after adjusting for demographic, socioeconomic, and clinical factors. Methods: In this cross-sectional study of emergency department (ED) data from the nationally representative National Hospital Ambulatory Medical Survey (NHAMCS), we examined multiple dimensions of ED care and treatment from 2005 to 2016 among children in the United States. The main outcomes include ED disposition (hospital admission, ICU admission, and in hospital death), resources utilization (medical imaging use, blood tests, and procedure use) and patient ED waiting times and total length of ED stay. The main exposure variable is race/ethnicity, categorized as non-Hispanic white (white), non-Hispanic black (Black), Hispanic, Asian, and Other. Analyses were stratified by race/ethnicity and adjusted for demographic, socioeconomic, and clinical factors. Results: There were 78,471 pediatric (≤18 years old) ED encounters, providing a weighted sample of 333,169,620 ED visits eligible for analysis. Black and Hispanic pediatric patients were 8% less likely (aOR 0.92, 95% CI 0.91-0.92) and 14% less likely (aOR 0.86, CI 0.86-0.86), respectively, than whites to have their care needs classified as immediate/emergent. Blacks and Hispanics were also 28 and 3% less likely, respectively, than whites to be admitted to the hospital following an ED visit (aOR 0.72, CI 0.72-0.72; aOR 0.97, CI 0.97-0.97). Blacks and Hispanics also experienced significantly longer wait times and overall visits as compared to whites. Conclusions: Black and Hispanic children faced disparities in emergency care across multiple dimensions of emergency care when compared to non-Hispanic white children, while Asian children did not demonstrate such patterns. Further research is needed to understand the underlying causes and long-term health consequences of these divergent patterns of racial disparities in ED care within an increasingly racially diverse cohort of younger Americans. SN - 2296-2360 UR - https://www.unboundmedicine.com/medline/citation/31956644/Racial_and_Ethnic_Disparities_in_Emergency_Department_Care_and_Health_Outcomes_Among_Children_in_the_United_States_ L2 - https://doi.org/10.3389/fped.2019.00525 DB - PRIME DP - Unbound Medicine ER -
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