Pediatric injury outcomes in racial/ethnic minorities in California: diversity may reduce disparity

Abstract

Hypothesis: Differences in health outcomes are well documented in adult racial/ethnic minorities. We hypothesize that similar differences exist in pediatric racial/ethnic minorities because their care is a function of their parents' access. We investigated this issue by examining pediatric injury outcomes in California.

Design: Retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database.

Setting: Sample of all California hospitalized patients.

Patients: In a sample of patients aged 18 years or younger at admission, injury patients were defined as having International Classification of Diseases, Ninth Revision, primary diagnosis codes between 800 and 959, with certain exclusions, from January 1, 1999, through December 31, 2010.

Main outcome measures: Adjusted risk of in-hospital death, controlling for age, sex, injury severity measured by survival risk ratio, Charlson comorbidity index, insurance status, admission year, teaching hospital status, and mechanism of injury.

Results: A total of 47 000 pediatric patients were identified. Bivariate analysis showed a significant difference in mortality by race/ethnicity among non-Hispanic whites (0.8%), blacks (1.2%), Hispanics (1.1%), Asians (1.2%), and American Indians/others (0.6%) (P = .01). However, with the exception of Asians (odds ratio, 0.32; 95% CI, 0.11-0.90), adjusted odds ratios of death relative to non-Hispanic whites for blacks (1.33; 0.71-2.46), Hispanics (1.06; 0.71-1.58), and American Indians/others (0.60; 0.17-2.10) showed no significant differences.

Conclusions: Unlike previous studies that have shown that adult racial/ethnic minorities (age, 18-64 years) have higher mortality relative to non-Hispanic whites, our study demonstrated no significant racial/ethnic differences among pediatric patients with injuries. It may be that differential access does not exist for children. In addition, it may also be possible that the diversity in California leads to culturally competent care and such care has been reported to improve patient outcomes.