Racial Disparities Persist in Diagnostic Imaging for US Children

By Lisa Rapaport

February 10, 2021

(Reuters Health) - Black and Hispanic children are less likely than white children to get diagnostic imaging as part of an emergency department evaluation at children's hospitals, a U.S. study suggests.

Researchers examined data on more than 13 million emergency department visits by 6.23 million children and adolescents at 44 U.S. children's' hospitals between 2016 and 2019. Overall, diagnostic imaging was done during 3.69 million visits (28.2%).

Compared to non-Hispanic white children and adolescents, the chances of receiving diagnostic imaging were significantly lower for non-Hispanic Black (adjusted odds ratio 0.82) and Hispanic youth (aOR 0.87) after accounting for potential confounders such as insurance, income, age, time of day, and diagnosis.

Results were consistent in analyses stratified by public and private insurance groups and did not materially differ by diagnostic category, the study team notes in JAMA Network Open.

Several factors may play a role in this disparity, said lead study author Dr. Jennifer Marin of the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.

These factors might include implicit bias on the part of clinicians, an increased likelihood that white parents and guardians may push for imaging, and a greater chance that white children may have a medical home and primary care provider that advises parents on what tests should be done in the emergency room, Dr. Marin said by email.

The bigger question is whether the children and adolescents received appropriate care, Dr. Marin said.

"If minority children did not receive imaging that was indicated, then those children are at risk for poorer outcomes, delays in diagnosis, more testing down the road, etc.," Dr. Marin said. "However, if white children are receiving imaging that is unnecessary, then we are exposing children to a test that can cause more harm than benefit."

When researchers limited their analysis to only nonhospitalized patients, they still found a lower likelihood of diagnostic imaging for Black (aOR 0.79) and Hispanic patients (aOR 0.84).

One limitation of the study is that researchers lacked data on the indication for imaging, the study team notes. They also lacked data on illness severity, and it's possible that white children had higher acuity that influenced imaging decisions.

Implicit bias, socioeconomic factors, and issues of high-deductible health plans or high out-of-pocket expenses may have all played a role in imaging decisions, said Dr. Anupam Kharbanda, chief of critical care services at Children's Minnesota in Minneapolis, who wrote a commentary accompanying the study. Training might help reduce disparities in diagnostic imaging, Dr. Kharbanda said by email.

"Implicit bias training and anti-racism training have been shown in small studies to improve physicians' empathy and understanding of other cultures," Dr. Kharbanda said. "The hope is that by having a better understanding of other cultures and people who share different life experiences, we can start to break down the underlying bias that is evident."

SOURCE: https://bit.ly/36Yx6cP and https://bit.ly/2Z1CtUo JAMA Network Open, online January 29, 2021.