Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis

J Pediatr. 2023 Aug:259:113424. doi: 10.1016/j.jpeds.2023.113424. Epub 2023 Apr 20.


Objective: To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis.

Study design: Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile).

Results: We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11).

Conclusions: Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.

Keywords: health care disparities; osteomyelitis; pediatric.

Publication types

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

MeSH terms

  • Acute Disease
  • Adolescent
  • Black or African American
  • Child
  • Cross-Sectional Studies
  • Ethnicity
  • Hispanic or Latino / statistics & numerical data
  • Hospitalization* / statistics & numerical data
  • Humans
  • Length of Stay* / statistics & numerical data
  • Osteomyelitis* / epidemiology
  • Osteomyelitis* / ethnology
  • Osteomyelitis* / therapy
  • Racial Groups / statistics & numerical data
  • United States / epidemiology
  • White
  • Young Adult