Development of a Health Disparities Index: Proof of Concept with Chest Radiography in Asthma

J Pediatr. 2021 Nov;238:290-295.e1. doi: 10.1016/j.jpeds.2021.07.022. Epub 2021 Jul 17.


Objectives: To develop a tool for quantifying health disparity (Health Disparity Index[HDI]) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept.

Study design: This was a retrospective cohort study using the Pediatric Health Information System database including children with asthma between 5 and 18 years old. Inpatient and emergency department (ED) encounters from January 1, 2017, to December 31, 2018, with low or moderate severity were included. Exclusions included hospitals with <10 cases in any racial/ethnic group. The HDI measured variation in CXR use among children with asthma based on race/ethnicity. The HDI was calculated as the absolute difference between maximum and minimum percentages of CXR use (range = 0-100) when there was statistical evidence that the percentages were different.

Results: Data from 36 hospitals included 16 744 inpatient and 75 805 ED encounters. Overall, 19.7% of encounters had a CXR (34.3% for inpatient; 16.5% for ED). In inpatient encounters, 47.2% (17/36) of hospitals had a significant difference in imaging across racial/ethnic groups. Of these, the median hospital-level HDI was 19.4% (IQR 13.5-20.1). In ED encounters, 78.8% (28/36) of hospitals had a statistically significant difference in imaging across racial/ethnic groups, with a median hospital-level HDI of 10.2% (IQR 8.3-14.1). There was no significant association between the inpatient HDI and ED HDI (P = .46).

Conclusions: The HDI provides a practical measure of disparity. To improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable. Next steps include application of this index to other conditions.

MeSH terms

  • Adolescent
  • Asthma / diagnostic imaging*
  • Asthma / ethnology
  • Black or African American / statistics & numerical data*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Status Disparities
  • Healthcare Disparities / ethnology*
  • Hispanic or Latino / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Procedures and Techniques Utilization
  • Proof of Concept Study
  • Radiography, Thoracic / statistics & numerical data*
  • Retrospective Studies
  • White People / statistics & numerical data*