Study finds racial inequity in imaging rates at pediatric EDs

By Erik L. Ridley, staff writer

June 3, 2022 -- A large cross-sectional study encompassing 38 children's hospitals and more than 12 million pediatric emergency department (ED) visits has found significant differences in imaging utilization among racial and ethnic groups.

A multi-institutional research team led by Dr. Margaret Samuels-Kalow of Massachusetts General Hospital analyzed imaging rates for 48 pediatric EDs over a four-year period. The group found that non-Hispanic white children were significantly more likely to receive diagnostic imaging studies than non-Hispanic Black and Hispanic children, according to the research published June 1 in JAMA Network Open.

"These findings suggest the need for interventions at the hospital level to improve equity in imaging in pediatric emergency medicine," the authors wrote.

In an effort to measure potential hospital-related factors that are associated with differences in the use of diagnostic imaging by race and ethnicity, the researchers analyzed administrative data from pediatric EDs at 38 U.S. tertiary care children's hospitals from January 1, 2016, to December 31, 2019.

Based on the data found in the Children's Hospital Association's Pediatric Health Information System, the researchers categorized race and ethnicity into the following four groups:

  • Hispanic of any race
  • non-Hispanic white
  • non-Hispanic Black
  • non-Hispanic other

The non-Hispanic group included multiracial, Asian, American Indian, and Native patients. Due to the heterogeneity in this group, the researchers elected to focus their analysis on non-Hispanic white, non-Hispanic Black, and Hispanic patients.

Overall, there were 12.3 million pediatric ED visits in the study, including 4.4 million (35.9%) among non-Hispanic white patients, 3.5 million among Hispanic patients (28.3%), and 3.2 million visits (26.1%) among non-Hispanic Black patients. Of the pediatric ED visits, 3.5 million (28.7%) resulted in at least one imaging test, including radiography, CT, MRI, and ultrasound.

Samuels-Kalow and colleagues found significantly higher imaging utilization rates for non-Hispanic white children compared with non-Hispanic Black and Hispanic children (p < 0.001).

Lower pediatric ED imaging rates for Hispanic and non‑Hispanic Black children
  Non‑Hispanic white children Hispanic Children Non‑Hispanic Black Children
Imaging performed per visits 34.2% 26.1% 24.6%

"Consistently, non-Hispanic Black patients were less likely to undergo imaging than non-Hispanic white patients across all hospitals and imaging modalities; similarly Hispanic patients were less likely to undergo imaging than non-Hispanic white patients, although the results were less consistent for [ultrasound] and MRI," the authors wrote.

Notably, non-Hispanic Black patients were also less likely to be imaged than Hispanic patients for all imaging studies and particularly for ultrasound, according to the researchers.

In other results, the researchers found a significant correlation between the proportion of patients from minoritized groups cared for at the hospital and greater imaging difference between non-Hispanic Black patients (coefficient correlation = -0.37, p = 0.02).

"Overall, these data show differences in imaging rates by race and ethnicity across children's hospitals and suggest that hospitals with a higher percentage of pediatric patients from minoritized groups have larger differences in imaging between non-Hispanic Black and white patients," the authors wrote. "Additionally, these data do not support the hypothesis that racial and ethnic differences in imaging are associated with underlying variation in hospital propensity to image, emphasizing the need for additional work to develop interventions to improve the equity and appropriateness of imaging in pediatric emergency medicine."

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