O2052: Racial Disparities in LOS for Common Pediatric Diagnoses: Trends from 2016 to 2019

Background: Healthcare disparities are widely known to exist in pediatric illness, with unequal outcomes demonstrated among non-White 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. In our prior work using the 2016 Kids’ Inpatient Database (KID), we found longer LOS for non-White children compared with White peers in the 10 most common diagnoses. The aim of this study was to trend the association between race and LOS for the same common diagnoses in 2019.

Methods: We utilized the 2019 KID from the Agency for Healthcare Research and Quality, the largest all-payer pediatric inpatient care database. For the same top 10 medical and surgical diagnoses identified in our 2016 study (bronchiolitis, pneumonia, diabetes, dehydration, asthma, sepsis, appendicitis, sickle cell, urinary tract infection (UTI), and upper respiratory infection (URI)), we used univariate negative binomial regression to evaluate the association between race and LOS. For diagnoses with significant associations, we performed multivariable analysis adjusting for age, sex, illness severity, payer, median income, and hospital type/region. We then compared effect sizes between the 2019 and 2016 data.

Results: The 10 diagnoses accounted for 225,528 hospital admissions in 2019. Univariate analysis demonstrated significantly longer LOS for non-White children compared to White children for 8 of the 10 diagnoses (Table 1). On multivariate analysis, LOS remained significantly longer for one or more non-White race in 6 of the diagnoses (Table 2). When compared with 2016, 2019 data showed greater disparities in LOS for Black children with sepsis, Hispanic children with appendicitis, and other non-White children with diabetes. Disparities in LOS decreased for Black children with diabetes, appendicitis, and UTI, Hispanic children with diabetes, asthma, and sepsis, and other non-White children with UTI. There were new LOS disparities found in 2 diagnoses, and 3 diagnoses with disparities in one minority race that were no longer seen.

Conclusion: The 2019 data continue to show disparities in LOS for non-White pediatric patients in common diagnoses. Although improving for some, these disparities persisted in 2019 for most of the diagnoses in which they were seen in 2016, with some showing greater or new disparities. This trend suggests further work will be important to further understand these disparities and their implications, as even small increases in LOS have a high cost across thousands of admissions.