Racial Disparities in Children Hospitalized with Asthma at Academic Childrens' Hospitals

Abstract

Disparities by race are known for children with asthma in the outpatient setting and post-hospital discharge. We sought to investigate if racial disparities also occur during hospitalization for children with asthma. The Pediatric Health Information System, a 35-hospital dataset from fiscal year 2003, was analyzed for patient-level, institution-level, utilization, and outcome variables that were associated with racial disparities. Of 17,406 admissions, blacks represented 51% and whites, 40%. Black patients were more likely to be insured by government sources (p < 0.001) and to be admitted in the mild severity category (p < 0.001). Blacks had a shorter mean length of stay (p < 0.01) but overall were more likely to receive bronchodilators (p < 0.0001) and steroids (p < 0.05). Length of stay and charges varies by insurance, with significant racial differences seen in government and "other" insurance types. Readmissions varied, with more whites readmitted within 72 hours (p < 0.002), but more blacks readmitted within 1 year (p < 0.0001). Demographic differences are consistent with national trends. Differences exist in severity at admission, medication use, influence of insurance, and readmissions, raising the need for further research into the impact of extrinsic factors; some, specifically severity at admission and medication use, may be important indicators of equity in the face of different disease burdens. Importantly, no differences in outcome in terms of medical complications or disposition were found. Some differences exist in care for asthmatic black and white children hospitalized in pediatric academic hospitals but not to the degree seen in other settings. (Pediatr Asthma Allergy Immunol 2006; 19[3]:162–171).