Children's National Hospital, Washington, District of Columbia.
George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Pediatrics. 2024 Mar 1;153(3). doi: 10.1542/peds.2023-063714.
Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events.
In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity.
Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children.
Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.
医疗保健差异普遍存在，但对于儿科安全方面的差异知之甚少。我们分析了一项全国性的住院患者样本，以确定安全事件方面的差异。
在这项基于人群的回顾性队列研究中，研究对象为 2019 年《儿童住院数据库》中的患者。自变量为种族、民族和支付方。结果为美国医疗保健研究与质量局儿科安全指标（PDI）。使用白色和私人支付者参考组计算风险调整后的优势比。通过按支付方分层来评估种族和民族的差异。
5243750 名出院患者的种族和民族为白人，占 46%；西班牙裔，占 19%；黑人，占 15%；缺失，占 8%；其他种族/多种族，占 7%；亚裔美国人/太平洋岛民，占 5%；和美国原住民，占 1%。每 10000 名出院患者的 PDI 发生率（每 10000 名出院患者）分别为新生儿血流感染 331.4 例，术后呼吸衰竭 267.5 例，术后败血症 114.9 例，术后出血/血肿 29.5 例，中心静脉血流感染 5.6 例，意外穿刺/撕裂伤 3.5 例，医源性气胸 0.7 例。与白人患者相比，黑人患者和西班牙裔患者在 7 项 PDI 中有 5 项具有显著更高的优势比；最大的差异发生在术后败血症（调整后的优势比，1.55 [1.38-1.73]）黑人患者和术后呼吸衰竭（调整后的优势比，1.34 [1.21-1.49]）西班牙裔患者。与私人保险患者相比，医疗补助覆盖的患者在 7 项 PDI 中有 4 项具有显著更高的优势比；最大的差异发生在术后败血症（调整后的优势比，1.45 [1.33-1.59]）。分层分析表明，即使在私人保险的儿童中，种族和民族差异仍然存在。
确定了黑人儿童和西班牙裔儿童的安全事件存在差异，表明需要采取有针对性的干预措施来提高医院的患者安全。
