Johns Hopkins University, Baltimore, MD, USA.
Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
Am J Emerg Med. 2021 Jul;45:65-70. doi: 10.1016/j.ajem.2021.01.095. Epub 2021 Feb 26.
While significant racial inequities in health outcomes exist in the United States, these inequities may also exist in healthcare processes, including the Emergency Department (ED). Additionally, gender has emerged in assessing racial healthcare disparity research. This study seeks to determine the association between race and the number and type of ED consultations given to patients presenting at a safety-net, academic hospital, which includes a level-one trauma center.
Retrospective data was collected on the first 2000 patients who arrived at the ED from 1/1/2015-1/7/2015, with 532 patients being excluded. Of the eligible patients, 77% (74.6% adults and 80.7% pediatric patients) were black and 23% (25.4% adults and 19.3% pediatric patients) were white.
White and black adult patients receive similar numbers of ED consultations and remained after gender stratification. White pediatric males have a 91% higher incidence of receiving an ED consultation in comparison to their white counterparts. No difference was found between black and white adult patients when assessing the risk of receiving consultations. White adult females have a 260% higher risk of receiving both types of consultations than their black counterparts. Black and white pediatric patients had the same risk of receiving consultations, however, white pediatric males have a 194% higher risk of receiving a specialty consultation as compared to their white counterparts.
Future work should focus on both healthcare practice improvements, as well as explanatory and preventive research practices. Healthcare practice improvements can encompass development of appropriate racial bias trainings and institutionalization of conversations about race in medicine.
在美国，健康结果存在显著的种族不平等现象，但这些不平等现象也可能存在于医疗保健过程中，包括急诊科（ED）。此外，在评估种族医疗保健差异研究时，性别也已经出现。本研究旨在确定在一家提供医疗服务的学术医院（包括一级创伤中心）就诊的患者中，种族与 ED 就诊次数和类型之间的关联。
回顾性收集了 2015 年 1 月 1 日至 2015 年 1 月 7 日期间到达 ED 的前 2000 名患者的数据，其中 532 名患者被排除在外。在符合条件的患者中，77%（74.6%为成年人，80.7%为儿科患者）为黑人，23%（25.4%为成年人，19.3%为儿科患者）为白人。
白人成年患者和黑人成年患者接受的 ED 就诊次数相似，在性别分层后仍然如此。与白人患者相比，白人儿科男性接受 ED 就诊的几率高 91%。在评估接受就诊的风险时，没有发现黑人和白人成年患者之间存在差异。与黑人患者相比，白人成年女性接受两种类型就诊的风险高 260%。黑人和白人儿科患者接受就诊的风险相同，但与白人患者相比，白人儿科男性接受专科就诊的风险高 194%。
未来的工作应同时关注医疗保健实践的改进以及解释性和预防性研究实践。医疗保健实践的改进可以包括开发适当的种族偏见培训，并将关于种族的讨论纳入医学实践中。
