From the Journals

Racial disparities not seen in child asthma hospitalizations

Publish date: December 28, 2016

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Real disparity issues found in outpatient, community care

The “most disturbing disparities in asthma care” are tied to the practices that limit or deny both outpatient and community care to pediatric Medicaid patients, wrote Lisa D. Young, MD, and Jay G. Berry, MD, MPH, in an accompanying editorial (Pediatrics 2016 Dec 26. doi: 10.1542/peds.2016-3485). “Although we are pleased that Silber and [his] colleagues’ work reports parity in hospital use for children with asthma by race, it will remain important to shine light on other disparities in children with asthma until those disparities are eliminated.”

Among the reasons that such care is either limited or denied is that in some states, Medicaid payments do not underwrite “the cost of the time and effort intensive health services required to optimize the health of the children. Moreover, some states recurrently threaten or enact reductions in funding for their Medicaid program. These legislative actions undoubtedly deincentivize outpatient pediatric providers to care for children with Medicaid,” they wrote.

Dr. Young is affiliated with the Pediatric Clinic and the East Alabama Medical Center, Auburn; Dr. Berry is with the division of general pediatrics at Boston Children’s Hospital and with Harvard Medical School, Boston. No conflicts of interest were declared.

A study of racial disparities in the hospitalization outcomes of children with asthma in the Medicaid system has found no significant differences in outcomes such as revisit and readmission rates, a study published online Dec. 26 shows.

Researchers examined the outcomes for 11,079 matched pairs of black and white children from the same state, admitted for asthma during a nearly 2-year period across 33 states. The black and white patients were matched on clinical characteristics (Pediatrics. 2016 Dec 26. doi: 10.1542/peds.2016-1221).

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Jeffrey H. Silber, MD, PhD, and his coauthors found no significant differences between black and white children in 10-day revisit rates (3.8% vs. 4.2%; P = .12), and 30-day revisit and readmission rates (10.5% vs. 10.8%; P = .49). Both black and white children had a median length of stay of 2 days, while slightly fewer black patients than white patients exceeded their own state’s median length of stay (30.2% vs. 31.8%, P = .01).

However, the study did find that ICU use was significantly higher among black patients, compared with white patients in four states (22.2% vs. 17.5%, P less than .001). Only 23 deaths were recorded among the 22,158 patients – 12 among black patients and 13 among white; a difference that was not significant.

“Because the number of children in Medicaid continues to increase due to the Affordable Care Act, it will be important to keep monitoring for potential racial disparities in hospitalization treatment styles and patient outcomes,” wrote Dr. Silber, of the Children’s Hospital of Philadelphia, and his coauthors. “Because our study was large, including more than 11,000 pairs of patients, we did see some statistically significant differences between black and white Medicaid patients in ICU use and [length of stay], but in most cases, such differences were small in any economic or clinical sense.”

The authors did note some key limitations of study, including a reliance on retrospective Medicaid claims from billing records – which they said may have led to false positives or negatives – and an absence of data on household smoking status and controller medication compliance, both of which could influence readmission and revisit risk.

Dr. Silber and his coauthors also pointed out that children were matched within the state, not within the hospital. “If black children went to worse hospitals than whites, we may not have seen these outcome differences if whites were matched to blacks always within the same hospital.”

The study was supported by the Agency for Healthcare Research and Quality. No conflicts of interest were declared.

pdnews@frontlinemedcom.com

Racial disparities not seen in child asthma hospitalizations

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