Non-Hispanic Black, Hispanic children less likely to undergo diagnostic imaging

Non-Hispanic Black and Hispanic children were less likely to undergo radiography, CT, ultrasonography and an MRI during ED visits than non-Hispanic white children, an analysis of more than 13 million ED visits showed.

“An important determinant of health care quality is the appropriate use of diagnostic testing for evaluating acute illness in children,” Jennifer R. Marin, MD, MSc, an associate professor of pediatrics and emergency medicine and medical director of point-of-care ultrasound at University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, and colleagues wrote.

The researchers reviewed administrative data from 13,087,522 pediatric ED visits by 6,230,911 children who presented at 52 tertiary care children’s hospitals in 27 states plus the District of Columbia. The mean age of the children who received radiography, CT, ultrasonography or an MRI during the 4-year study period was 5.8 years, and 52.7% were boys. Among the participants, 34.4% were non-Hispanic white, 25.5% were non-Hispanic Black, 28.4% were Hispanic and 11.7% indicated their race as other. Across all race and ethnic groups, at least 44.2% of the ED visits were covered by public insurance and less than 15% resulted in hospitalization.

Marin and colleagues reported that imaging was conducted during 28.2% of all the studied visits. Overall, imaging was performed in 33.5% of non-Hispanic whites compared with 26.1% of Hispanics (OR = 0.66; 95% CI, 0.66-0.67) and 24.1% of non-Hispanic Blacks (OR = 0.6; 95% CI, 0.6-0.6). After adjusting for confounders, visits by non-Hispanic Blacks (adjusted OR [aOR] = 0.82; 95% CI, 0.82-0.83) and Hispanics (aOR = 0.87; 95% CI, 0.87-0.87) were less likely to include any imaging vs. visits by non-Hispanic whites.

When limiting the analysis to nonhospitalized patients, visits by non-Hispanic Blacks (aOR = 0.79; 95% CI, 0.79-0.8) and Hispanics (aOR = 0.84; 95% CI, 0.84-0.85) were still less likely to include imaging than visits by non-Hispanic whites. Results were “consistent” in analyses that stratified by insurance type and did not “materially differ” by diagnostic category, according to the researchers.

“Although we were unable to discern underuse from overuse using an administrative database, it is likely that much of the imaging in white children is unnecessary,” Marin and colleagues wrote.

They added that adherence to guidelines and other “objective scoring tools” as well as internal quality assurance evaluations may help close the disparity gap.

In a related editorial, Anupam B. Kharbanda, MD, MSc, a physician at Children’s Minnesota, wrote that the findings are consistent with previous studies and “should not come as a surprise.”

He added that all health care professionals “carry biases” and recommended three strategies for providing more equitable health care: implicit bias and antiracism training; addressing structural racism in health systems, which could be done by partnering with community-based organizations; and employing a diverse workforce that is indicative of the populations the health system serves.

References

Kharbanda AB. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.34019.

Marin JR, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.33710.