Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals

Authors

Kavita Parikh, Children's National Hospital, Washington, District of Columbia.
Matt Hall, Children's Hospital Association, Lenexa, Kansas.
Joel S. Tieder, Seattle Children's Hospital, Seattle, Washington.
Gabrina Dixon, Children's National Hospital, Washington, District of Columbia.
Maranda C. Ward, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Pamela S. Hinds, Children's National Hospital, Washington, District of Columbia.
Monika K. Goyal, Children's National Hospital, Washington, District of Columbia.
Shawn J. Rangel, Boston Children's Hospital, Boston, Massachusetts.
Glenn Flores, Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, Florida.
Sunitha V. Kaiser, University of California, San Francisco, California.

Document Type

Journal Article

Publication Date

3-1-2024

Journal

Pediatrics

Volume

153

Issue

3

DOI

10.1542/peds.2023-063714

Abstract

BACKGROUND AND OBJECTIVES: Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. METHODS: In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. RESULTS: Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. CONCLUSIONS: Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.

APA Citation

Parikh, Kavita; Hall, Matt; Tieder, Joel S.; Dixon, Gabrina; Ward, Maranda C.; Hinds, Pamela S.; Goyal, Monika K.; Rangel, Shawn J.; Flores, Glenn; and Kaiser, Sunitha V., "Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals" (2024). GW Authored Works. Paper 4602.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4602

Department

Pediatrics