Length of stay is one way to determine the quality of care that patients have access to, and this study focuses on comparing length of stay across racial disparities for various pediatric conditions, including asthma.
Inequities in childhood disease can manifest in a number of ways, and tend to be disparate across racial, ethnic, and economic lines. Length of stay is one way to assess the quality of health care that patients receive, and it tends to be associated with higher costs and increased complications. Previous studies have shown that length of stay disparities exist for Black and Hispanic children for specific diagnoses, but the prevalence of these disparities is not clear, based on the current research. This article, published in Hospital Pediatrics, analyzes the way that these disparities present for the most common pediatric diagnoses, including asthma, appendicitis, and diabetes mellitus. The research is based on data gathered from 2016 to 2019, including over 450,000 admissions.
Disparities in Length of Stay Are Common for Many Pediatric Diseases
For each year during the study period, the authors mapped an association between race and length of stay using a generalized linear mixed effects model with a negative binomial distribution to account for clustering and confounding. The 10 most common primary diagnoses, accounting for 267,522 hospitalizations in total, were bronchiolitis, pneumonia, diabetes, dehydration, asthma, sepsis, appendicitis, sickle cell disease, urinary tract infection (UTI), and upper respiratory infection (URI). Approximately half of all patients in each year were non-White. About 60% had public insurance, and 35% came from a home with a median household income in the lowest quartile. Statistically significant relationships were found between race and ethnicity and length of stay for 8 of the top 10 diagnoses, which was lowered to 7 of the top 10 diagnoses in 2019. Significant increases in length of stay persisted in 4 out of 5 diagnoses for Black children, as well as 3 out of 5 for Hispanic children. For asthma in particular, disparities decreased and were no longer present at all for Hispanic children, while for other conditions length of stay disparities increased.
Racial Asthma Disparities on the Decline, but Overall Results Are Still Mixed
Although length of stay disparities were initially found for asthma, they improved significantly over the course of the study. This may be the result of consistent use of asthma action plans as a reference tool for parents and caregivers, as well as other asthma-focused resources, such as nurse services. Although additional data are needed to understand how and why the length of stay for pediatric asthma declined, it could serve as a useful blueprint for reducing length of stay disparities in other pediatric conditions. Additionally, further research is needed to better understand how the decrease in this disparity affects overall pediatric asthma outcomes.
Harrington, Y., Rauch, D. A., & Leary, J. C. (2023). Racial and Ethnic Disparities in Length of Stay for Common Pediatric Diagnoses: Trends From 2016 to 2019. Hosp Pediatr. https://doi.org/10.1542/hpeds.2021-006471