Health Disparities and Constipation Management among Pediatric Patients in the Emergency Department

J Natl Med Assoc. 2020 Oct;112(5):541-549. doi: 10.1016/j.jnma.2020.05.011. Epub 2020 Jul 3.


Introduction: Constipation is a common cause of abdominal pain in children. Prior studies have demonstrated that nearly half of the children with constipation receive enemas; however, studies regarding constipation management based on race and ethnicity have not been pursued. The goal of this investigation is to determine if demographic disparities namely, race and ethnicity and insurance status affect emergency department (ED) management of constipation and prescription of enema.

Methods: This was a retrospective cross-sectional study utilizing ED 2005-2016 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) in children <21 years old. Groups were analyzed according to race and also by insurance status. We performed adjusted survey binomial regression to evaluate the association between patient characteristics and receipt of enema among patients with constipation.

Results: 3,168,240 children with constipation were seen in a sampling of EDs during the study period. 12.9% (408,937) received an enema. There was no statistically significant difference for Non-Hispanic Black and Hispanic patients to receive enema (OR: 0.92, CI: [0.47-1.82] and OR: 0.81, CI: [0.34-1.91], respectively) as compared to Non-Hispanic White patients. While Medicare patients were more likely to receive an enema (OR 187.76, CI [2,35-149.65]) compared to Medicaid patients, there was no difference between Medicaid patients and private payers.

Discussion: Racial and health disparities do not appear to impact a physician's decision on giving an enema to children with constipation presenting to the ED.

Keywords: Constipation; Emergency department; Enema; Health disparity in constipation.

MeSH terms

  • Adult
  • Aged
  • Child
  • Constipation / epidemiology
  • Constipation / therapy
  • Cross-Sectional Studies
  • Emergency Service, Hospital*
  • Healthcare Disparities
  • Humans
  • Medicare*
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult