As with many health outcomes, a child is more likely to be hospitalized if they live in a family with low income and/or are of a minority race.
More studies are trying to understand why it is that there are socioeconomic, racial, and ethnic disparities for so many health outcomes.
Cole Brokamp, PhD, at the University of Cincinnati and colleagues in the Responding to Identified Sociomedical Risks with Effective Unified Purpose (RISEUP) Study Research Team did a deep dive to try to understand mechanisms that might explain the inequities in pediatric hospitalizations. Their article, entitled “Causal Mediation of Neighborhood-Level Pediatric Hospitalization Inequities,” is being early released in Pediatrics (10.1542/peds.2023-064432).
The authors took an interesting approach. Their hypothesis was that “complex historical processes” were the root cause of inequities at the neighborhood level. They then used statistical models to estimate how much of the inequities could be explained by neighborhood-based social, economic, and environmental exposures, such as:
- Material deprivation index
- Proportion of households speaking a language other than English
- Fraction of homes that are rented
- Fraction of households headed by a single parent
- Crime risk
- Time to drive to nearest hospital (in other words, access to hospital)
- Fraction of land that is “green space”
The authors report that these neighborhood characteristics could explain nearly all the inequities in hospitalization. These characteristics accounted for 53% of the inequities in hospitalizations for asthma, 67% of the inequities for type 1 diabetes hospitalizations, and 98% of the inequities in hospitalizations for psychiatric diagnoses.
If we are going to decrease these inequities, we need to work at the community and population levels to eliminate these elements of structural racism. I urge you to read this paper as a start. The authors discuss the importance of partnerships with professional organizations and public entities to start this important work.
