P4A099: Disparities in Pediatric Safety Events in US Hospitals

Background: Healthcare disparities are persistent and pervasive, but not enough is known about disparities in pediatric safety events to design targeted interventions. Our objective was to analyze a national sample of pediatric hospitalizations to identify disparities in pediatric safety that could inform equity-focused system improvements.

Methods: Population-based, retrospective cohort study using data from the 2019 Kids’ Inpatient Database (KID), which includes 80% of US pediatric hospital discharges. Independent variables were patient race/ethnicity, classified as White, Black, Hispanic, Asian or Pacific Islander (PI), Other Race or Multi-Race; and payor, classified as Medicaid or private insurance. Outcomes were pediatric safety indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). Risk-adjusted odds ratios (aOR) using AHRQ clinical severity adjustments were calculated using White and Private payor reference groups (groups historically least likely known to experience disparities). Stratified analyses were completed by race/ethnicity and payor status.

Results: Of 5,243,750 discharges, 77% were < 1 year old and 48% were female. Race/ethnicity included 46% White, 19% Hispanic, 15% Black, 8% missing, 7% Other Race or Multi-Race, 5% Asian/PI, and 1% Native American. Overall PDI rates (per 10,000 discharges) were 0.7 for iatrogenic pneumothorax (lowest PDI rate), 3 for accidental puncture/laceration, 6 for central-line blood stream infection, 30 for post-operative hemorrhage/hematoma, 115 for post-operative sepsis, 268 for post-operative respiratory failure, and 331 for neonatal blood stream infection (highest PDI rate). In adjusted analyses, compared with White patients, Black and/or Hispanic patients had significantly greater odds of 5 of 7 PDIs. Figure 1. Black patients had the largest disparity in post-operative sepsis (aOR, 1.54 [1.38-1.73]); and Hispanic patients had the largest disparity in post-operative respiratory failure (aOR, 1.34 [1.21-1.49]). In adjusted analyses, compared with Private payor status patients, Medicaid status patients had significantly greater odds in 4 of 7 PDIs. Figure 2. Stratified analyses demonstrated persistent disparities by race/ethnicity, even among privately insured children.

Conclusion: Black and Hispanic children have significantly higher risks of avoidable safety events in the US hospitals. Action and targeted interventions that address barriers to health equity are needed.