Black and Hispanic children are more likely to experience safety issues in hospitals than white children, a new study found.
Children with public insurance also have higher rates of safety issues compared to children with private insurance, according to “Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals” (Parikh KP, et al. Pediatrics. Feb. 12, 2024).
“Furthering our understanding of disparities in pediatric safety events is a critical, foundational step to ultimately testing and implementing interventions to improve patient safety for historically disadvantaged children and achieve health equity for all children,” authors wrote.
The team analyzed data on 5.2 million hospital patients under 18 years of age from the 2019 Kids’ Inpatient Database. They looked at the odds of seven pediatric-specific quality indicators — accidental puncture or laceration, iatrogenic pneumothorax, postoperative hemorrhage or hematoma, postoperative sepsis, postoperative respiratory failure, central venous catheter-related bloodstream infections and neonatal bloodstream infections.
Black patients had significantly higher odds of postoperative hemorrhage or hematoma, postoperative respiratory failure, postoperative sepsis, central venous catheter-related bloodstream infection and neonatal bloodstream infection compared to white patients. The biggest difference between the two groups was seen in postoperative sepsis, for which Black children had an adjusted odds ratio of 1.55.
Hispanic patients had significantly higher odds of postoperative respiratory failure, postoperative sepsis and neonatal bloodstream infections compared to white children. The adjusted odds ratio was 1.34 for postoperative respiratory failure in Hispanic children.
Odds of iatrogenic pneumothorax were lower for Black and Hispanic children compared to white children, and there were no disparities for accidental puncture/laceration, according to the study.
Medicaid patients had higher rates of all three postoperative conditions as well as central venous catheter-related bloodstream infections compared to those with private insurance. When looking only at children with private insurance, racial disparities persisted.
“It is reasonable … to consider several plausible factors, including structural racism in the US health care system, clinician bias, insufficient cultural responsiveness, communication barriers, and/or impaired access to high-quality and timely health care,” authors wrote.
They cited several frameworks for addressing health equity that called for examining quality and safety data in depth, partnering with communities and families, and designing and testing equity-focused quality improvement initiatives.
The author of a related commentary said the findings put pediatricians at a crossroads in addressing disparities in health care.
“Despite proudly identifying ourselves as child health advocates, we are letting them down,” the author wrote. “… We must mobilize around this issue, and we will. For if we don’t, we will fail not just our patients but ourselves.”
Addressing racial inequities in health care has been a priority for the AAP, which has created an Equity Agenda, released the policy Eliminating Race-Based Medicine and hired its first chief health equity officer and senior vice president, equity initiatives.
Resources
- AAP policy Eliminating Race-Based Medicine
- AAP Equity Agenda
- Truth, Reconciliation, and Transformation: Continuing on the Path to Equity from the AAP Board of Directors
- AAP Perspective: Race-Based Medicine from the AAP Board of Directors and Executive Committee
