Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions

J Pediatr. 2017 Jul;186:158-164.e1. doi: 10.1016/j.jpeds.2017.03.046. Epub 2017 Apr 21.

Abstract

Objective: To compare the timing and magnitude of variation of pediatric readmission rates across race/ethnicity for selected chronic conditions: asthma, diabetes, seizures, migraines, and depression.

Study design: Retrospective analysis of hospitalizations at 48 children's hospitals in the 2013 Pediatric Health Information System database for children (ages 0-18 years) admitted for asthma (n = 36 910), seizure (n = 35 361), diabetes (n = 12 468), migraine (n = 5882), and depression (n = 5132). Generalized linear models with a random effect for hospital were used to compare the likelihood of readmission by patients' race/ethnicity, adjusting for severity of illness, age, payer, and medical complexity. Adjusted readmission rates were calculated by week over 1 year.

Results: Significant variation in adjusted readmission rates by race/ethnicity existed for conditions aside from depression. Disparities for diabetes and asthma emerged at 3 and 4 weeks, respectively; they remained divergent up to 1 year with the highest 1-year readmission rates in non-Hispanic blacks vs other race/ethnicities (diabetes: 21.7% vs 13.4%, P < .001; asthma: 21.4% vs 14.6%, P < .001). Disparities for migraines and seizure emerged at 6 and 7 weeks, respectively; they remained up to 1 year, with the highest 1-year readmission rates in non-Hispanic whites vs other race/ethnicities (migraine: 17.3% vs 13.6%, P < .001; seizure: 23.9% vs 21.9%, P < .001).

Conclusions: Readmission disparities behave differently across chronic conditions. They emerge more quickly after discharge for children hospitalized with asthma or diabetes than for seizures or migraines. The highest readmission rates were not consistently observed for 1 particular race/ethnicity. Study findings can impact pediatric chronic disease management to improve care for children with these conditions.

Keywords: asthma; children; depression; diabetes; migraine; pediatrics; readmissions; seizures.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Asthma / ethnology*
  • Child
  • Child, Preschool
  • Chronic Disease
  • Depressive Disorder / ethnology*
  • Diabetes Mellitus / ethnology*
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Migraine Disorders / ethnology*
  • Patient Readmission / statistics & numerical data*
  • Retrospective Studies
  • Seizures / ethnology*
  • United States