Children from racial and ethnic minority groups and those covered by public insurance receive fewer radiology studies in the emergency department (ED) than their white, privately-insured peers, researchers have found.
As well, hospitals with stronger pediatric capabilities do little to narrow the gap, according to a team led by Margaret Samuels-Kalow, MD, MPhil, of Massachusetts General Hospital in Boston. The results were published May 20 in JAMA Network Open.
"This study suggests that additional efforts are needed to ensure that efforts to enhance pediatric capabilities address both the quality and equity of care," the group wrote.
Careful use of imaging in pediatric emergency care is a well-established quality measure, but previous studies have shown variability in imaging use across hospitals and "persistent racial and ethnic differences in pediatric imaging rates, with … [white] patients consistently more likely to receive imaging compared with … Black patients and Hispanic patients," it explained, noting that "prior data [has suggested] that hospitals with a higher percentage of patients from racial and ethnic minoritized groups have larger differences in imaging by race and ethnicity."
Samuels-Kalow and colleagues sought to investigate this phenomenon via a study that included data from 857,034 ED visits from 2019 across eight states. They examined the following three imaging measures considered markers of appropriate care:
- Chest x-ray for asthma (380,719 ED visits; mean age, 9.6 years)
- Head CT for head trauma (435,644 ED visits; mean age, 7.2 years)
- Abdominal CT for abdominal trauma (40,671 ED visits; mean age, 11 years)
After adjusting for age, sex, clinical severity, and hospital factors, the team found that children with public insurance were less likely to have undergone imaging across all measures compared with those with private insurance (asthma: adjusted odds ratio [AOR], 0.85; head trauma: AOR, 0.77; and abdominal trauma: AOR, 0.59). This disparity was most acute for abdominal trauma, where publicly-insured children had 41% lower odds of receiving a CT scan, the investigators noted.
They also reported racial and ethnic disparities. Compared with non-Hispanic white children, non-Hispanic Black children had 17% lower odds of chest radiography for asthma, 23% lower odds of head CT, and 40% lower odds of abdominal CT.
Finally, the group wrote that "the presence of pediatric capability was associated with differences in imaging utilization, but not with changes in the pattern of association between either insurance or race and ethnicity and imaging utilization."
The takeaway? "Although optimal imaging rates are closely linked with the underlying severity of the patient population and may be challenging to describe from administrative data alone, it is critical that imaging decisions are based on clinical factors and not on demographic characteristics," the authors concluded.
Access the full study here.
