Doctors order fewer imaging tests for Black and Hispanic children compared to their white peers, according to new research published in JAMA Network Open.
Pediatric and emergency medicine experts from top healthcare institutions analyzed emergency department billing data from 52 hospitals across the U.S. over a four-year period for their study. They found Black children are 18% less likely to undergo imaging during their ED visit than their white peers, and Hispanic kids 13% less likely.
The disparity may be partially rooted in different patient preferences and physician’s implicit bias, according to lead author Jennifer Marin, MD, MSc, associate professor of pediatrics, emergency medicine and radiology at the University of Pittsburgh School of Medicine.
"Something else is going on here that's beyond the clinical, that's beyond the diagnoses," Marin, also medical director of point-of-care ultrasound at UPMC Children’s Hospital in Pittsburgh, added in a statement. "Cultural factors that come with people's race, gender, religion, etc., should not be associated with testing when getting that test is clearly not beneficial to the patient and potentially harmful."
To reach their conclusions, the team used data from the Pediatric Health Information System from hospitals in 27 states and the District of Columbia spanning 2016 to 2019. In total, 13,087,522 visits by 6, 230,911 children and adolescents 18 years or younger were included.
The group also adjusted their data to control for confounding factors, such as health insurance, diagnosis and household income. And even then, they found doctors ordered “significantly” fewer imaging exams for Black and Hispanic children. This finding was even stronger among individuals not admitted to the hospital, which suggests such children were not greatly injured or sick, the authors explained.
Marin and colleagues hypothesized that these testing disparities are driven by performing unnecessary tests in white children, although their data couldn’t discern between warranted and unwarranted imaging.
In an editorial related to the Jan. 29 study, Anupam B. Kharbanda, MD, MSc, with the Department of Pediatric Emergency Medicine at Children’s Minnesota, said the findings are important, but shouldn’t come as a surprise.
“Hospitals across the U.S. do not provide equal care to patients who present for an emergent evaluation; children of color, similar to their parents and grandparents, receive care that is different from what is provided to their non-Hispanic white peers,” Kharbanda added.
The editorialist also called on health systems to prioritize employing a diverse workforce that reflects the populations it serves and urged physicians, researchers, and leadership to partner with the communities they work in to create and implement interventions that address the “substantial inequities in care.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.