Infectious Disease

Non-Hispanic Black, Hispanic youngsters who’re much less prone to have diagnostic imaging

January 29, 2021

2 min read

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Kharbanda and Marin do not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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

“An important determinant of health care quality is the appropriate use of diagnostic tests to assess 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 the Children’s Hospital of the University of Pittsburgh Medical Center in Pittsburgh, and colleagues wrote.

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

The researchers reviewed administrative data from 13,087,522 pediatric ED visits by 6,230,911 children presented at 52 children’s tertiary care hospitals in 27 states and the District of Columbia. The mean age of children who received radiography, CT, ultrasound, or 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% non-Hispanic-black, 28.4% Hispanic, and 11.7% reported their race as others. Across all races and ethnic groups, at least 44.2% of ED visits were publicly insured and less than 15% resulted in hospitalizations.

Marin and colleagues reported that imaging was performed on 28.2% of all visits examined. 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 confounding factors, visits from non-Hispanic blacks (adjusted OP [aOR] = 0.82; 95% CI, 0.82-0.83) and Hispanics (aOR = 0.87; 95% CI, 0.87-0.87) received less imaging than visits from non-Hispanic whites.

When limiting the analysis to non-hospitalized patients, the likelihood of visits from non-Hispanic blacks (aOR = 0.79; 95% CI, 0.79-0.8) and Hispanics (aOR = 0.84; 95% CI, 0.84-0.85) included imaging, even less than visits from non-Hispanic whites. The results were “consistent” in analyzes that were stratified by insurance type and, according to the researchers, did not “differ significantly” according to diagnostic categories.

“Although we were unable to distinguish overuse from overuse using an administrative database, it is likely that much of the imaging will not be required in white children,” wrote Marin and colleagues.

They added that adherence to guidelines and other “objective assessment tools”, as well as internal quality assurance assessments, can help close the inequality gap.

In a related editorial Anupam B. Kharbanda, MD, MSc, A doctor from Children’s Minnesota wrote that the results are consistent with previous studies and “shouldn’t come as a surprise.”

He added that all health professionals are “biased” and recommended three strategies for more equitable health care: implicit bias and anti-racism training; Combating structural racism in health systems that could be achieved through partnerships with community level 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.

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Race and medicine

Race and medicine

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