Differences in severity – adjusted paediatric hospitalisation rates associated with race/ethnicity

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Authors:

Chamberlain JM et al

June 26, 2007

Summary:

The authors aimed to test the hypothesis that severity-adjusted emergency department paediatric admission rates were associated with race/ethnicity. Patient data (n = 8,952) relating to ethni-city and severity of illness were collected randomly from an established database of 16 emergency departments. Data for Black and Hispanic patients were similar and were combined. White patients had higher crude (8.2 vs 5.3%) and severity-adjusted (1.71 vs 1.1) admission rates in comparison to Black and Hispanic patients. In the highest quintiles of illness severity, standardised admission ratio’s for Black and Hispanic patients were close to 1.0, whereas admission rates for White patients were 1.5 to 2.0 times that expected in the 2 lowest quintiles of severity. The authors concluded that these results are “more consistent with high rates of discretionary admissions for White patients with low illness severity than with under-admitting severely ill Black or Hispanic patients”.

Comment:

That three of the 16 emergency departments recorded ethnicity in less than 10% of patients is appalling. The authors have quite rightly highlighted this point in the paper and excluded those sites from the analysis. The other interesting finding is that White children are more likely to be admitted to hospital than Black/Hispanic children at these centres. The authors state that this difference is due to the higher rates of ‘discretionary’ admissions for White patients with non severe disease. Two points I’d like to raise – doctors do appear to play a role in deciding who is admitted to hospital; the decision is not based on clinical factors alone. Secondly I know how difficult it can be to look after a sick child at home. Do the results suggest that White kids and their families benefit from hospital admission while Black/Hispanic families are left to manage at home without support?

Reference: Pediatrics 2007; 119(6)

Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Differences in severity – adjusted paediatric hospitalisation rates associated with race/ethnicity

Independent commentary by Dr. Matire Hardwood

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Differences in severity – adjusted paediatric hospitalisation rates associated with race/ethnicity

Independent commentary by Dr. Matire Hardwood

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