Antibiotic prescribing rates in pediatric emergency departments vary by race and ethnicity

1. Non-Hispanic (NH) white children were more likely to be prescribed antibiotics for viral acute respiratory tract illnesses (ARTIs) in pediatric emergency departments (PEDs) when compared to children of other races and ethnicities.

Evidence Rating Level: 2 (Good)

Study Rundown: While previous studies have shown race/ethnicity -based discrepancies in utilization rates of various diagnostic and treatment strategies in the PED, no studies have examined the potential role of race and ethnicity on antibiotic prescribing in this setting. In the current study, researchers analyzed data collected from 7 PEDs to describe the possible relationship between antibiotic use for viral ARTIs and patient race/ethnicity. Results showed that NH white children had above average rates of antibiotic prescriptions, while NH blacks had below average rates of antibiotic prescriptions for viral ARTIs in the studied PEDs. Hispanic children and other NH children received antibiotics at approximately average rates. These trends were consistent within and across sites, and were independent of age, acuity level, insurance status, and provider type. One limitation of this study was the inclusion of data solely from pediatric specific emergency departments (EDs) in large academic centers, which may have resulted in lower rates of antibiotic misuse than general EDs and those not affiliated with academic centers. Results from this investigation are consistent with previous studies showing differences in care management based on race and ethnicity. Findings highlight the need to further examine factors contributing to these discrepancies in order to reduce disparities in care.

Click to read the study, published today in Pediatrics

Relevant reading: Racial differences in antibiotic prescribing by primary care pediatricians

In-depth [retrospective cohort]: Researchers analyzed data from 39 445 patient visits (50.5% NH black, 46% female, 77.5% covered by Medicaid, average age = 3.3 years) from 7 academically-affiliated PEDs to compare differences in antibiotic prescription rates for viral ARTIs based on race and ethnicity. Results showed antibiotics were prescribed at an average of 2.6% (95%CI 2.4-2.8) of PED visits for viral respiratory illness. NH white children received antibiotics with the highest frequency, followed by other NH children, Hispanic children, and NH black children (4.3%, 2.9%, 2.6%, and 1.9% respectively). NH white children were 2 times more likely to get antibiotics than NH black children (OR 0.41; 95%CI 0.35-0.49) and about 1.5 times more likely than Hispanic children (OR 0.57; 95%CI 0.47-0.69). Results were similar after adjusting for other demographic variables such as age, provider type, and level of visit acuity. No significant differences were found based on provider type, however the majority of prescribers (66.3%) were categorized as either pediatricians or PED attendings.

Image: PD

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