Children and adolescents, including those with a cancer diagnosis, were less likely to undergo diagnostic imaging during an emergency department visit at a children’s hospital if they were racial minorities, found a cross-sectional study recently published in JAMA Network Open.1 Previous studies have shown that use of imaging can vary by race, with most of the prior research having been done at medical centers for adults, said Anupam Kharbanda, MD, MSc, Department of Pediatric Emergency Medicine at Children’s Minnesota in Minneapolis, during an interview with Cancer Therapy Advisor. He was not involved in the study and authored a corresponding editorial on the study.2

What is different about this study, Dr Kharbanda explained, is the use of a huge dataset that evaluated multiple diagnoses in patients from multiple hospitals over a span of multiple years. “It provided that definitive evidence that there is a disparity,” he said. 

To conduct the study, lead author Jennifer Marin, MD, MSc, Department of Pediatrics at the University of Pittsburgh School of Medicine in Pennsylvania, and her coauthors evaluated administrative data from more than 13 million emergency department visits for more than 6 million children and adolescents, aged up to 18 years.

Emergency department visits occurred over a 4-year span at 44 children’s hospital emergency departments in the United States and were grouped by patient race and ethnicity: non-Hispanic White (34.4%), non-Hispanic Black (25.5%), Hispanic (28.4%), and Other (11.7%). Visits were assessed for receipt of diagnostic imaging, which was defined as radiography, ultrasonography, computed tomography, and magnetic resonance imaging, and 28.2% of the visits were found to include diagnostic imaging.


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An analysis that adjusted for potential confounders found that patients who were non-Hispanic Black were 18% less likely than non-Hispanic White patients to undergo imaging (adjusted odds ratio [aOR]=0.82; 95% CI, 0.82-0.83). Similarly, patients who were Hispanic were 13% less likely than non-Hispanic White patients to undergo imaging (aOR=0.87; 95% CI, 0.87-0.87). When the analysis was restricted to visits among patients who were discharged, allowing the researchers to exclude sicker patients who became hospitalized, minority patients continued to be less likely to undergo imaging than non-Hispanic White patients.

When patients were evaluated based on diagnosis, a difference was seen among those who fell in the major diagnostic category of lymphatic, hematopoietic, or other malignancies. Hispanic children who had a major diagnostic category of lymphatic, hematopoietic, or other malignancies were 15% more likely to receive imaging compared with non-Hispanic White children (aOR=1.15; 95% CI, 1.01-1.31).

“One or more groups here is getting suboptimal care,” said Dr Marin, during an interview with Cancer Therapy Advisor. As to which group was over or under imaged, she explained that the study could not answer that question because outcomes data could not be collected. 

To avoid this difference in imaging, Dr Kharbanda encouraged hospital systems to become more community oriented and adopt antiracism training. “That training can come in very different forms, but the underlying pillar of it is to try to generate empathy, not sympathy, among the physicians and clinicians who are caring for these other populations.”

Also, the physicians and clinicians in the leadership roles should be racially diverse and represent their patient populations. Dr Kharbanda explained that if the people providing the care represent the community they serve, it helps increase alignment and dialog, especially if they are in a leadership role.

References

  1. Marin JR, Rodean J, Matt Hall M, et al. Racial and ethnic differences in emergency department diagnostic imaging at US children’s hospitals, 2016-2019. JAMA Netw Open. 2021;4(1):e2033710. doi:10.1001/jamanetworkopen.2020.33710
  2. Kharbanda AB. Racial inequities in pediatric emergency care. JAMA Netw Open. 2021;4(1):e2034019. doi:10.1001/jamanetworkopen.2020.34019