Department of Surgery, University of California, San Diego, La Jolla, CA, USA.
JAMA Surg. 2013 Jan;148(1):76-80. doi: 10.1001/2013.jamasurg.3.
Differences in health outcomes are well documented in adult racial/ethnic minorities. We hypothesize that similar differences exist in pediatric racial/ethnic minorities because their care is a function of their parents' access. We investigated this issue by examining pediatric injury outcomes in California.
Retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database.
Sample of all California hospitalized patients.
In a sample of patients aged 18 years or younger at admission, injury patients were defined as having International Classification of Diseases, Ninth Revision, primary diagnosis codes between 800 and 959, with certain exclusions, from January 1, 1999, through December 31, 2010.
Adjusted risk of in-hospital death, controlling for age, sex, injury severity measured by survival risk ratio, Charlson comorbidity index, insurance status, admission year, teaching hospital status, and mechanism of injury.
A total of 47 000 pediatric patients were identified. Bivariate analysis showed a significant difference in mortality by race/ethnicity among non-Hispanic whites (0.8%), blacks (1.2%), Hispanics (1.1%), Asians (1.2%), and American Indians/others (0.6%) (P = .01). However, with the exception of Asians (odds ratio, 0.32; 95% CI, 0.11-0.90), adjusted odds ratios of death relative to non-Hispanic whites for blacks (1.33; 0.71-2.46), Hispanics (1.06; 0.71-1.58), and American Indians/others (0.60; 0.17-2.10) showed no significant differences.
Unlike previous studies that have shown that adult racial/ethnic minorities (age, 18-64 years) have higher mortality relative to non-Hispanic whites, our study demonstrated no significant racial/ethnic differences among pediatric patients with injuries. It may be that differential access does not exist for children. In addition, it may also be possible that the diversity in California leads to culturally competent care and such care has been reported to improve patient outcomes.
成人种族/民族少数群体的健康结果差异已有充分记录。我们假设，儿科种族/民族少数群体也存在类似的差异，因为他们的医疗取决于其父母的可及性。我们通过研究加利福尼亚州的儿科伤害结果来调查这个问题。
对加利福尼亚州卫生规划和发展办公室医院出院数据库进行回顾性分析。
加利福尼亚州所有住院患者样本。
在入院时年龄为 18 岁或以下的患者样本中，将受伤患者定义为具有国际疾病分类，第九修订版，主要诊断代码在 800 至 959 之间，具有某些排除情况，时间范围为 1999 年 1 月 1 日至 2010 年 12 月 31 日。
调整后的院内死亡风险，控制年龄、性别、生存风险比衡量的伤害严重程度、Charlson 合并症指数、保险状况、入院年份、教学医院状况和损伤机制。
共确定了 47000 名儿科患者。单变量分析显示，非西班牙裔白人（0.8%）、黑人（1.2%）、西班牙裔（1.1%）、亚洲人（1.2%）和美洲印第安人/其他族裔（0.6%）之间的死亡率存在显著差异（P =.01）。然而，除了亚洲人（比值比，0.32；95%置信区间，0.11-0.90）之外，与非西班牙裔白人相比，黑人（1.33；0.71-2.46）、西班牙裔（1.06；0.71-1.58）和美洲印第安人/其他族裔（0.60；0.17-2.10）的死亡调整比值比无显著差异。
与先前表明成人种族/民族少数群体（年龄 18-64 岁）的死亡率相对非西班牙裔白人较高的研究不同，我们的研究表明，受伤的儿科患者中没有明显的种族/民族差异。可能是儿童的差异化就医并不存在。此外，加利福尼亚州的多样性也可能导致文化能力的护理，并且已经有报道称这种护理可以改善患者的预后。
