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Treatment at ED for children with abdominal pain varies by race
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Black and low socioeconomic status children were more likely to experience disparities in treatment after admission to the ED with abdominal pain than white children, according to a recent study.
“Our analysis … serves as quantifiable evidence to highlight the differential care and outcomes that exist in the health care system associated with nondisease patient attributes,” Louise Wang, PhD, of the School of Medicine at Stanford University, and colleagues wrote. “Longer wait times for surgery for blacks, Hispanics, and low income children could potentiate complicated appendicitis.”
The researchers analyzed data, gathered from the Pediatric Health Information System, on 4.2 million pediatric patients with abdominal pain from 43 U.S. children’s hospitals from 2004 to 2011. Patients were classified by whether their abdominal pain was organic or functional. The researchers also classified patients on whether they were admitted to an ICU, received imaging, were diagnosed with appendicitis, or had a perforated appendix.
Data showed that race and income disparities were significantly associated with health outcomes. Black (adjusted OR = 1.42; 95% CI, 1.32-1.53) and low income (aOR = 1.2; 95% CI, 1.14-1.25) children were at an increased risk for perforated appendix. Black children also were more likely to be admitted to an ICU (aOR = 1.92; 95% CI, 1.53-2.42) and have longer hospital stays (aHR = 0.91; 95% CI, 0.86-0.96) than white children.
Black, Hispanic and low socioeconomic status children also were less likely to receive imaging for their abdominal pain. Wang and colleagues noted that white children were more likely to receive surgery than blacks, Hispanics, and low income children, even after an appendicitis diagnosis.
Treatment differences may be related to the fact that EDs are accessed more frequently by patients who lack medical insurance, the investigators said.
“In our study, blacks and Hispanics had significantly fewer health insurance resources, which has been linked to lack of access to a primary care physician for early monitoring of medical conditions as people in poorer health were more than twice as likely to use the ED,” Wang and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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