Black and Hispanic children were less likely than non-Hispanic White children to undergo diagnostic imaging in the emergency department, according to results from a cross-sectional study.
The study, published in JAMA Network Open, showed that imaging disparities were consistent across most diagnostic groups, and didn’t change when stratified by either public or private insurance type.
“Our findings suggest that a child’s race and ethnicity may be independently associated with the decision to perform imaging during ED visits,” concluded the study’s authors, who were led by Jennifer R. Marin, MD, MSc, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
As pointed out by Marin and her colleagues, the issue of disparities in health care delivery and quality has become urgent, particularly with the 2010 publication of a report from the American Academy of Pediatrics highlighting “extensive, pervasive, and persistent” disparities in the pediatric health care. And considering that diagnostic imaging of pediatric patients is commonly performed in emergency departments, disparities in the use of imaging across racial and ethnic groups has potential of delivering suboptimal care to non-White children.
In a previous study, Marin and her colleague found that non-Hispanic White children had higher odds of receiving advanced imaging compared with non-White patients. Here they wanted to evaluate whether these disparities exist across imaging modalities and persist depending upon diagnosis and insurance type.
The study included data from 52 tertiary care U.S. children’s hospitals and encompassed ED visits by patients under the age of 18 from January 1, 2016, through December 31, 2019. The primary outcome of the study was the proportion of visits for each race/ethnicity group with at least 1 diagnostic imaging study (radiography, CT, Ultrasound, and MRI).
Of the 13,087,522 visits by children and adolescents to emergency departments during the study period, diagnostic imaging was performed in 28.2%. Imaging was performed in 33.5% of visits by non-Hispanic White patients compared with 24.1% of visits by non-Hispanic Black patients (odds ratio [OR], 0.60; 95% CI, 0.60- 0.60) and 26.1% of visits by Hispanic patients (OR, 0.66; 95% CI, 0.66-0.67). And when adjusted for relevant confounders, visits by non-Hispanic Black and Hispanic patients were less likely than those by non-Hispanic White patients to include any imaging (aORs of 0.82 and 0.87, respectively)
These patterns persisted across modalities and when stratified by insurance type.
Across 26 diagnostic categories, imaging was less likely to be performed on non-Hispanic Black patients than non-Hispanic White patients in 15 categories, and more likely in 4 categories (skin and subcutaneous conditions, blood and immunological conditions, mental health conditions, and hepatobiliary and pancreatic conditions). There was no difference in the other 7 categories.
Imaging was less likely to be performed on Hispanic patients than non-Hispanic White patients in half of the 26 diagnostic categories, and more likely in 2 categories (mental health conditions, and lymphatic, hematopoietic, and other malignancies). There was no difference in 11 categories.
The results suggest that imaging could be underused in non-Hispanic Black and Hispanic children, or potentially overused in non-Hispanic White children, Marin and her colleagues observed. Each scenario has negative implications since underuse can result in misdiagnoses and worse outcomes, while overuse exposes children to unnecessary risks associated with imaging (such as radiation exposure).
Marin and her colleagues suggested that it is likely that much imaging of White children is unnecessary, and that explanations for imaging disparities could also include “a combination of parent/ guardian preferences, clinician biases, and structural factors.”
“Further investigation is needed to better understand the factors underpinning these disparities, with the goal of developing measurable interventions to mitigate the disparities in ED imaging and allowing for more equitable and improved care,” the authors concluded.
In a commentary accompanying the study, Anupam B. Kharbanda, MD, MSc, Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis, suggested that its findings should come as no surprise since they are consistent with previous research documenting inequalities based on race and ethnicity.
Kharbanda highlighted 3 approaches that can be taken that can begin to address the root causes of inequities in care: Healthcare professionals need to recognize that everyone carries biases, health systems must address the structural racism that exists within hospitals or health systems, and health care system workforces should be diverse and reflect the population they serve.
Addressing this issue is particularly urgent, Kharbanda added, considering the U.S. currently faces a pandemic that disproportionately affects Black, Hispanic, and Native American communities.
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Be aware that Black and Hispanic children may be less likely than non-Hispanic White children to undergo diagnostic imaging in emergency departments.
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These disparities persist across most diagnosis groups and when stratified by insurance type.
Michael Bassett, Contributing Writer, BreakingMED™
Marin and Kharbanda reported no disclosures.
Cat ID: 254
Topic ID: 253,254,254,585,730,138,192,925,481
