Cornelius B Groenewald1, Helen H Lee2, Nathalia Jimenez3, Odinakachukwu Ehie4, Jennifer A Rabbitts5. 1. Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, United States. Electronic address: cornelius.groenewald@seattlechildrens.org. 2. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, United States; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States. 3. Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, United States. 4. Department of Anesthesia and Perioperative Services, University of California, San Francisco, United States. 5. Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105, United States; Center for Clinical and Translation Research, Seattle Children's Hospital, Seattle, WA, United States.
Abstract
OBJECTIVES: Children of minority background have reduced access to surgery. This study assessed for racial/ethnic differences in surgical utilization by location. MATERIALS AND METHODS: We conducted a cross-sectional analysis of U.S. children (0-17 years of age) participating in the nationally representative Medical Expenditure Panel Survey (MEPS, 2015-2018). Race/ethnicity was the variable of interest. The primary outcome variables were prevalence rates of surgery defined by location of surgical procedure (inpatient, emergency department, hospital outpatient, and office). Covariates included contextual factors that may influence access to and need for healthcare services, including age, sex, insurance status, residential geographic status, usual source of care, and parental reports of child's physical and mental health. We employed multivariate logistic regression models to assess the relationship between outcomes and race/ethnicity. RESULTS: The study population included 31,024 children with an overall surgical rate of 4.8%. Adjusted odds of surgery in an ambulatory location were lower for all racial/ethnic minority groups compared to non-Hispanic White counterparts (non-Hispanic Black aOR = 0.3, 95% CI: 0.2-0.5; Hispanic aOR = 0.4, 95% CI: 0.3-0.6; non-Hispanic Asian aOR = 0.2, 95% CI 0.0-0.5 for hospital outpatient surgery; for office-based setting, non-Hispanic Black aOR = 0.4, 95% CI 0.3-0.6; Hispanic aOR = 0.5, 95% CI: 0.4-0.7; non-Hispanic Asian aOR = 0.4; 95% CI 0.3-0.7). No racial/ethnic differences were observed for surgical procedures in inpatient or emergency department locations. CONCLUSIONS: Staggering differences exist in pediatric surgery utilization patterns by racial/ethnic background, even after adjusting for important contextual factors (income, insurance, health status). Our findings in a nationally representative dataset may suggest systemic barriers related to racial/ethnic background for the pediatric surgical population.
OBJECTIVES: Children of minority background have reduced access to surgery. This study assessed for racial/ethnic differences in surgical utilization by location. MATERIALS AND METHODS: We conducted a cross-sectional analysis of U.S. children (0-17 years of age) participating in the nationally representative Medical Expenditure Panel Survey (MEPS, 2015-2018). Race/ethnicity was the variable of interest. The primary outcome variables were prevalence rates of surgery defined by location of surgical procedure (inpatient, emergency department, hospital outpatient, and office). Covariates included contextual factors that may influence access to and need for healthcare services, including age, sex, insurance status, residential geographic status, usual source of care, and parental reports of child's physical and mental health. We employed multivariate logistic regression models to assess the relationship between outcomes and race/ethnicity. RESULTS: The study population included 31,024 children with an overall surgical rate of 4.8%. Adjusted odds of surgery in an ambulatory location were lower for all racial/ethnic minority groups compared to non-Hispanic White counterparts (non-Hispanic Black aOR = 0.3, 95% CI: 0.2-0.5; Hispanic aOR = 0.4, 95% CI: 0.3-0.6; non-Hispanic Asian aOR = 0.2, 95% CI 0.0-0.5 for hospital outpatient surgery; for office-based setting, non-Hispanic Black aOR = 0.4, 95% CI 0.3-0.6; Hispanic aOR = 0.5, 95% CI: 0.4-0.7; non-Hispanic Asian aOR = 0.4; 95% CI 0.3-0.7). No racial/ethnic differences were observed for surgical procedures in inpatient or emergency department locations. CONCLUSIONS: Staggering differences exist in pediatric surgery utilization patterns by racial/ethnic background, even after adjusting for important contextual factors (income, insurance, health status). Our findings in a nationally representative dataset may suggest systemic barriers related to racial/ethnic background for the pediatric surgical population.
Authors: Elzerie de Jager; Adele A Levine; N Rhea Udyavar; Helen R Burstin; Nizar Bhulani; David B Hoyt; Clifford Y Ko; Joel S Weissman; L D Britt; Adil H Haider; Melinda A Maggard-Gibbons Journal: J Am Coll Surg Date: 2019-03 Impact factor: 6.113
Authors: Charles Liu; Melinda Maggard-Gibbons; Thomas G Weiser; Arden M Morris; Yusuke Tsugawa Journal: Ann Surg Date: 2021-12-01 Impact factor: 13.787