Racial Disparities in LOS for Common Pediatric Diagnoses in 2016

Background: Healthcare disparities are widely known to exist in pediatric illness, with unequal treatment and outcomes demonstrated among minority children compared with white peers. Length of stay (LOS) is used as a primary benchmark in assessing quality of hospital care and has been associated with higher costs and complications. For individual diagnoses such as appendicitis, studies have found minority children to have a prolonged LOS in comparison to white peers, but it is unclear if this disparity exists more broadly. The aim of this study was to examine the association of race with LOS for the most common pediatric medical and surgical diagnoses in the inpatient setting.

Methods: We utilized the 2016 Kids’ Inpatient Database (KID) from the Agency for Healthcare Research and Quality, the largest all-payer pediatric inpatient care database. We excluded admissions for normal newborn care and psychiatric diagnoses, and then the 10 most frequent primary medical or surgical diagnoses were determined. For each of these 10 diagnoses, we used univariate linear regression to evaluate the association of race with LOS. For each diagnosis in which race was significantly associated with LOS, we then performed multivariable linear regression controlling for age, sex, severity of illness, insurance, median household income, hospital type, and hospital region.

Results: Representing a total of 267,522 hospital admissions, bronchiolitis, pneumonia, diabetes, dehydration, asthma, sepsis, appendicitis, sickle cell, UTI, and URI were the 10 most frequent primary diagnoses. Univariate analysis demonstrated significantly longer LOS for minority children compared to white children for 7 of the top 10 diagnoses (Table 1). On multivariate analysis, LOS remained significantly longer for one or more minority races for 5 of the diagnoses: diabetes, asthma, sepsis, appendicitis, and UTI (Table 2). Largest average increases in LOS were for black children with sepsis (0.48 days), other minority children with UTI (0.4 days), and black children with appendicitis (0.36 days).

Conclusion: The 2016 KID data shows significantly longer LOS for minority children with common pediatric diagnoses, including “ambulatory sensitive” conditions such as asthma and diabetes. Racial disparities such as decreased access to preventive care for minorities may contribute to increased LOS. Future directions could include mixed methods research to better understand the context and contributing factors to such racial disparities.