Examining Racial and Ethnic Differences in Referral and Management of Central Precocious Puberty in a Pediatric Endocrinology Clinic

Abstract

Objective: To evaluate racial and ethnic differences in referral timing, diagnostic evaluation, and treatment of central precocious puberty (CPP) among girls referred to a pediatric endocrinology clinic.

Study design: A retrospective chart review of female patients referred for early puberty between January 2010 and January 2023 and subsequently diagnosed with CPP. Extracted data included age at referral, race and ethnicity, insurance type, pubertal stage at first visit, laboratory evaluation, imaging, and treatment. Patients with alternative diagnoses, those referred for other endocrine concerns, or those transferring care with a prior CPP diagnosis were excluded. Statistical analyses were performed using SAS 9.4.

Results: Of 485 referred patients, 259 met inclusion criteria. Referral age did not differ significantly across racial and ethnic groups (P =.08), nor did age at endocrinology appointment (P =.17). Median time from referral to appointment differed across racial and ethnic groups (P =.04), although absolute differences were small. Tanner staging at presentation did not significantly differ (breast stage P =.10; pubic hair stage P =.09). Diagnostic evaluation, including laboratory testing and imaging, was similar by race and ethnicity. Gonadotropin-releasing hormone agonists were prescribed to 44-71% of patients across racial groups without significant difference (P =.40), and time from first endocrinology visit to treatment initiation did not differ (P =.13). However, cumulative time from referral to treatment initiation differed by race and ethnicity (P =.01). Analyses stratified by insurance type and neighborhood deprivation index showed no significant differences in referral timing, evaluation, or treatment.

Conclusions: We found no significant racial or ethnic disparities in CPP referral timing, evaluation, or treatment. A small difference in referral-to-appointment time was identified but is likely not clinically meaningful. Further research is needed to determine whether disparities in CPP recognition or referral patterns exist upstream from specialty care.

Keywords: disparities; endocrinology; equity; precocious puberty; puberty; referrals.