The US healthcare system needs to undergo further reform if racial disparities in pediatric surgical care are to be addressed, report researchers.
"This is the first study to compare the different inpatient health care settings and identify varying levels of potential racial disparities, particularly for Black children," say Stephen Shew (University of California, Los Angeles, USA) and team.
As reported in the Journal of American College of Surgeons, they found that overall rates of appendiceal perforation (AP) among 107,727 children were 32% at children's hospitals, followed by 28% at county hospitals, and 19% at community hospitals.
"Current literature has shown that racial minorities exhibit increased risk of AP independent of other socioeconomic factors," note the researchers. "Therefore, AP has been identified by the Department of Health and Human Services as a marker for racial disparities in health care delivery."
Multivariate analysis showed that in community hospitals, Hispanic and Asian children were at a significantly increased risk for AP compared with White children, at odd ratios (ORs) of 1.23 and 1.34, respectively, while Black children and those of other races did not show any increase in AP risk. Hispanic children were also at an increased likelihood for experiencing perforation if they were cared for at children's hospitals, at an OR of 1.18, compared with White children, while no such increase in risk was observed for other nonWhite children.
On the other hand, in county hospitals, no racial groups showed increased odds for AP when compared with White children.
"The county hospital system in California serves a largely low income, nonWhite population. It is perhaps not surprising then that public hospitals serving a particular demographic group exhibited less racial disparity within their own system," write the authors.
However, further analysis comparing hospital types showed that Black children (but not children of any other race) were significantly more likely to experience AP at both county and children's hospitals than at community hospitals, at ORs of 1.12 and 2.01, respectively.
Further study into possible triage biases for this population should be explored, says the team, but one possible explanation for the increased AP risk for Black children in county hospitals versus community hospitals is that the majority of nonWhite patients in California county Hospitals are Hispanic not Black, possibly creating a "biased culture within the county hospital system that affects Black children as the most under-represented minority."
The researchers say the differential patterns of AP at the hospital level deserve immediate attention because they may reflect far larger disparities in access and quality of care for children in California.
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