ORLANDO, Fla.— Unintentional injuries like falls, drownings and poisonings are the leading cause of death in patients ages 1-4, and a significant portion of these deaths are linked to unintentional ingestions—such as swallowing a drug or poison. New research shows racial and socioeconomic disparities exist in the emergency management of unintentional ingestions in children.
Black patients younger than age 6 with the diagnosis of unintentional ingestion were more likely than white children to have a social work consult, Children Services Bureau referral, and urine drug screen, according to a research abstract, “Disparities in the Emergency Evaluation and Management of Unintentional Ingestions in Preschool Children,” presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
The research also found that children from poorer backgrounds (lower childhood opportunity index), those with higher severity of illness and pharmaceutical ingestions resulted in either a social work consultation, a Children Services Bureau referral, or both.
“This study is important in understanding where underlying bias exists in emergency departments and hospital management and where changes can be made to address this problem, thus providing equitable care for all children,” said principal investigator Jennifer Allen, DO, FAAP. “These findings could be useful to healthcare workers in emergency departments to help develop a framework for standardized clinical decision making.”
Researchers examined the records of 4,411 patients, younger than age 6, who had unintentional ingestions between January 2013 and March 2024 identified by the International Classification of Disease in the electronic health record. They found:
“This isn’t the only research to find racial disparities in the emergency department,” Dr. Allen said. “Disparity has been identified among different races regarding pain management for fractures and appendicitis in the emergency department.”
Akron Children’s Hospital supported this research.
Study author Dr. Jennifer Allen is scheduled to present this research, which is below, from 2:30 - 2:40 p.m. Friday, Sept. 27, 2024, during the Section on Emergency Medicine program during the AAP’s National Conference and Exhibition.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Emergency Medicine
Abstract Title: Disparities in the emergency evaluation and management of unintentional ingestions in preschool children
Unintentional injuries consisting of trauma and poisonings are the leading cause of death in patients aged 1-4 years old with a significant portion attributed to ingestions. National Poison Control data in 2021 showed there were 37 incidences of poison exposure per 1000 children under 6 years old (2023). Between 2010-2019, poisoning deaths among minority children increased (West, 2021). Evidence of treatment disparity exists as seen in the decreased use of opioids or analgesia in minority children with long bone fractures or appendicitis in the emergency department (ED) (Goyal, 2015 and 2020). There is a knowledge gap regarding the extent, causes, and impact of disparities in assessing and managing acute ingestions in children. This study aimed to determine whether there is a difference in the evaluation and management of children with unintentional ingestions in a pediatric tertiary care center’s ED.
From January 2013 to March 2024, patients less than 6 years of age were identified by International Classification of Disease (ICD) 9 and 10 codes in the electronic health record (EHR). Independent variables included: race, childhood opportunity index (COI), payor status, severity, age, sex, and substance type. Dependent variables included: urine drug screen (UDS), social work (SW) consult, and child service bureau (CSB) referral. Summary statistics were calculated and described as mean (sd). The relationship between independent and dependent variables was described using odds ratio (OR) with 95% confidence interval (CI). The relationship between pharmaceutical ingestion type was described using the receiver operating characteristic curve (ROC). Significance was defined as p-value < 0.05. Races are defined as White, African American, and Other; due to low numbers in categories comparisons are between all White and Non-White children.
4411 patients had unintentional ingestions and most ingestions were non-pharmaceutical (56%). Patients with pharmaceutical ingestions had higher odds of a social work consult and a CSB referral (OR 8.3, 9.0). Independent of ingestion type, Non-White children were more likely to have a SW consult, CSB referral, and UDS order (ROC 0.78, 0.84, and 0.86). Looking at pharmaceutical ingestions, Non-White children had more cannabis ingestions than White children (Figure 1). Private insurance and ED discharge were associated with reduced odds of SW consults or CSB referral. A lower COI was associated with higher odds of SW consult and CSB referral (Table 1). When adjusted for COI, payor type, and severity, African Americans had higher odds of a SW consult, CSB referral, and UDS order (OR 1.8, 2.8, 2.3).
This study revealed there are racial disparities in the management of unintentional ingestions within the ED setting. The next step would be to discuss findings with ED professionals and develop a framework for standardized clinical decision making.
Childhood opioid prescription rates vary by patient’s background, research finds
Research presented during American Academy of Pediatrics 2024 Conference & Exhibition analyzes opioid prescriptions following fracture diagnoses
American Academy of Pediatrics
ORLANDO, Fla.—Children born to greater socioeconomic backgrounds are significantly more likely to be prescribed opioids, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
The abstract, “Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures,” looked at the rates in opioid prescriptions following childhood broken elbow diagnoses from 2012 to 2021.
Apurva Shah, MD, MBA, Attending Surgeon, Orthopaedic Surgery at the Children’s Hospital of Philadelphia, who authored the abstract, also pointed to results that showed a third of patients in the abstract received at least one opioid dose during their visit.
“As orthopaedic surgeons, we clearly need improved opioid use stewardship to improve healthcare outcomes for our patients,” Dr. Shah said.
Results found disparities in patient racial backgrounds, with Black children 27% less likely to receive an opioid prescription compared to other patients. By comparison, white patients were also shown to be 10% more likely to be given opioids.
Other factors that impacted patients’ likelihood of being given opioids included age and where they live, according to Dr. Shah.
“Non-opioid pain management has proven sufficient for pain management,” Dr. Shah said. “Knowing this, along with this abstract, pediatricians must consider the potential harm these drugs can have on populations with disproportionately easier access to healthcare.”
This research was funded by Children’s Hospital of Philadelphia, Division of Orthopaedics.
Scott Mahon is scheduled to present the research, which is below, at 8:51 – 8:55 a.m. on Sunday, Sept. 29 during the Section on Orthopaedics program at Orange County Convention Center, West Building, W311H. To request an interview with the authors, contact Ashley Moore at moorea1@chop.edu.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Orthopaedics
Abstract Title: Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures
Apurva Shah
Philadelphia, PA, United States
Nonmedical use of opioids in children and adolescents is a well-established public health concern. For many adolescent patients, an initial opioid prescription can act as a gateway that may lead to opioid misuse later in life. The purpose of this study is to investigate if patient factors, including sex, race, ethnicity, or Childhood Opportunity Index (COI), are associated with higher or lower likelihood of opioid prescription in children with fractures, utilizing pediatric supracondylar humerus fracture as an archetypal example.
Data was obtained from the Pediatric Health Information System (PHIS), an administrative database consisting of patient encounters across 52 pediatric hospitals. Patients with supracondylar humerus fractures who presented to an emergency department and were treated non-operatively were included. The primary outcome variable of interest was whether or not patients received an opioid prescription. We also extracted and assessed patient-level predictors for opioid use, including age, sex, race, ethnicity, primary payer, COI, and geographic region. To account for hospital level variation, we conducted mixed-effects logistic regression.
In total, 35,452 children (52% male) with non-operative supracondylar humerus fractures at a mean age of 5.7 ± 2.8 years were included. About one-third of patients (10,731; 30.3%) received at least one dose of opioids. After accounting for hospital-level characteristics, White patients were significantly more likely to receive an opioid prescription (OR 1.1, p=0.016), while those with public insurance were less likely (OR 0.85, p=0.001). Kids from moderate, high, and very high COI regions were significantly more likely to receive opioids compared to very low COI regions (OR 1.1-1.2). Additionally, older children (5-13 years) were significantly more likely to be prescribed more opioids compared to younger children (1-5 years) (OR 1.4, p< 0.001). No differences due to region or sex were found statistically significant. Results are further described in Table 1.
Opioids for supracondylar humerus fractures, despite the efficacy of non-opioid alternatives, are prescribed at high rates and disproportionately to White children and patients from higher COI areas, reflecting important socioeconomic disparities in opioid prescription patterns. Though non-opioid pain management using acetaminophen or ibuprofen provides sufficient pain control for treating supracondylar humerus fractures, unfortunately, almost one-third of patients being treated non-operatively were prescribed opioids. Our investigation demonstrates that White patients and children with higher COI are especially likely to be prescribed opioids, indicating that prescription pattern disparities may be harming the portion of the population that has historically had better access to healthcare.
Black infants with heart abnormalities more likely to die in first year
Study of infant mortalities from heart defects finds while death rates decreased, white infants more likely to survive than Black infants
Reports and ProceedingsAmerican Academy of Pediatrics
ORLANDO, Fla.— Some babies are born with abnormalities involving the structure of the heart, known as congenital heart disease (CHD). While many studies have shown that more babies with congenital heart disease are surviving past their first birthday as deaths from CHD have significantly decreased in the United States, a research abstract found that race impacts these survival rates.
Black infants with congenital heart disease are 40% more likely to die in the first year of life than white infants with congenital heart disease, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
The research, “Trend in Racial Differences in Mortality Attributed to Congenital Heart Diseases in Infants in the United States from 2005 to 2019," found that improvements in death rates for children with heart abnormalities were due to reduced death rates for white babies with congenital heart disease.
“The death rate in white infants decreased significantly but the rate in Black infants did not. Overall, we also found that Black infants died from these abnormal heart structures at a rate that was 1.4 times that of white infants,” said lead author Kwadwo Danso, MBChB.
Researchers examined data from the Centers for Disease Control and Prevention on 60,243,988 live births, which included 19,004 congenital heart disease-related infant deaths, to investigate if death rates varied based on race for children born with CHD. They found that the overall congenital heart disease infant mortality rate declined from 36.1 to 27.0 per 100,000 live births, down 25.2%. However, throughout the study, Black infants with congenital heart disease died at higher rates.
“Our findings may have implications for patient care and public health policy by serving as a foundation for additional studies to determine the drivers behind these disparities,” Dr. Danso said. “More research is needed on this disparity to understand why Black infants with congenital heart disease are more likely to die.”
Study author Kwadwo Danso, MBChB, is scheduled to present the research, which is below, during the Section on Cardiology and Cardiac Surgery program at the AAP’s National Conference and Exhibition.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Cardiology & Cardiac Surgery
Abstract Title: Trend in racial differences in mortality attributed to Congenital Heart Diseases in infants in the United States from 2005 to 2019
Kwadwo Danso
Peoria, IL, United States
Deaths from congenital heart disease (CHD) in children have been decreasing. We examined the differences in CHD mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants in the United States from 2005 to 2019. We hypothesized that a disparity in mortality rates exists between NHB and NHW infants.
We performed a retrospective cross-sectional analysis of publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research. The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P< 0.05 was considered statistically significant.
Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% confidence interval (CI)-2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P< 0.0001) and this difference remained when the CHD mortality rate was stratified by the neonatal and post-neonatal period. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], however, it was not significant in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 and there was no significant change during the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2).
The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was significantly higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.
Figure 1 shows the overall CHD-IMR decline over the study period
Figure 2 shows the NHB-NHW CHD IMR ratio over the time
Preterm births have increased by more than 10 percent over the past decade, with racial and socioeconomic disparities persisting over time, according to a new study analyzing more than five million births.
The study, published in the journal JAMA Network Open, also found that some factors that increase the risk for preterm birth—such as diabetes, sexually transmitted infections, and mental health conditions—became much more common over the past decade, while other factors that protect against preterm birth declined.
“Our findings not only show that preterm births are on the rise, but provide clues as to why this may be the case,” said Laura Jelliffe-Pawlowski, the study’s lead author, an epidemiologist and professor at the NYU Rory Meyers College of Nursing and professor emeritus of epidemiology, biostatistics, and of global health sciences in the University of California San Francisco (UCSF) School of Medicine. “Understanding patterns of and factors related to preterm birth is important for informing clinical care and the development of public health programs to address this critical need.”
Babies born preterm or prematurely—before the 37th week of pregnancy—are more likely to experience a range of short and longer-term problems, including a higher risk for illness, intellectual and emotional difficulty, and death. Certain factors are known to increase the risk of preterm birth, including mothers having high blood pressure, diabetes, an infection, or smoking. In addition, Black, Native American, and Hawaiian and Pacific Islander expectant mothers are at higher risk for preterm birth, which is thought to be driven by a long history of structural racism experienced by these groups.
To understand recent trends around preterm births, Jelliffe-Pawlowski and her colleagues looked at more than 5.4 million singleton births (not twins or other multiples) from 2011 to 2022 in the state of California. They examined how preterm birth rates changed over time and explored patterns in risk and protective factors within racial/ethnic and socioeconomic groups. Health insurance type was used as a proxy for socioeconomic status, comparing public insurance (MediCal, California’s Medicaid program) with nonpublic insurance (including private insurance and coverage through the military and the Indian Health Service).
A growing risk and “alarm bells”
The researchers found that preterm births increased by 10.6 percent over the decade studied, from 6.8 percent in 2011 to 7.5 percent in 2022—echoing a report from the Centers for Disease Control and Prevention (CDC) released earlier this year that also found an increase in preterm birth across the nation from 2014 to 2022.
Rates of preterm birth grew across nearly all groups, but varied by racial/ethnic and socioeconomic group. The highest rates of preterm birth were among Black mothers with public insurance (11.3 percent), while the lowest rates were among white mothers who had nonpublic insurance (5.8 percent). Preterm birth rates decreased slightly over time among Black mothers with nonpublic insurance, from 9.1 percent in 2011 to 8.8 percent in 2022, but were still significantly higher than rates among white mothers. In contrast, preterm birth rates jumped from 6.4 percent to 9.5 percent among Native American mothers with nonpublic insurance.
“We found stark differences in terms of what it looks like to be a Black or Native American pregnant person compared with a white individual who is of middle or higher income,” said Jelliffe-Pawlowski.
Expanding on the CDC report’s findings by looking at risk and protective factors over time, the researchers determined that several factors were linked to an increased risk for preterm birth, including diabetes, high blood pressure, previously having a preterm birth, having fewer than three prenatal care visits, and housing insecurity. Notably, the rates of preexisting diabetes, sexually transmitted infections, and mental health conditions more than doubled during the decade studied.
“These patterns and changes in risk factors should be setting off alarm bells,” said Jelliffe-Pawlowski.
Several factors were found to protect against preterm birth among low-income expectant mothers, including receiving prenatal care and participation in WIC, the supplemental nutrition program supporting women and children. Unfortunately, the researchers observed a decline in WIC participation across most low-income racial/ethnic groups over the period studied.
What can be done to improve birth outcomes
The researchers note that their findings underscore the need to improve pregnancy care and promote treatments that address risk factors associated with preterm birth—which are often underutilized during pregnancy, especially among mothers of color.
“We need to do a better job of sharing information with pregnant people about risk factors for preterm birth and interventions that may be able to help them address this risk. Some providers report not wanting to scare or overwhelm pregnant people, but pregnant people tend to report wanting to have this information,” said Jelliffe-Pawlowski. “For those who are at increased risk due to factors like hypertension or previous preterm birth, for example, providers should be having conversations about how taking low-dose aspirin might be helpful to them and their growing baby. This also extends to things like screening for sexually transmitted infections and offering mental health care in a non-judgmental, supportive way.”
“There is also important work to be done to improve structural issues and respectful care in WIC to increase participation,” added Jelliffe-Pawlowski.
Jelliffe-Pawlowski and her colleagues are also working to develop a digital platform called Hello Egg to help expectant mothers better understand their risk for preterm birth, identify interventions that may be helpful to them, and create a healthy pregnancy plan co-developed with prenatal providers. Jelliffe-Pawlowski and the team at the start-up, EGG Healthy Pregnancy, aim to conduct a large study to see if using the platform boosts a pregnant person’s knowledge; a key outcome will be seeing if this information sharing leads to increases in the use of interventions and, ultimately, to a reduced risk of preterm birth and other adverse outcomes.
The research was supported by the University of California, San Francisco California Preterm Birth Initiative. Additional study authors include Audrey Lyndon of NYU Meyers and collaborators from the University of California, San Francisco; University of California San Diego; Stanford University; UCLA Medical Center; California State University, Northridge; San Francisco State University; Indiana University Bloomington; University of Alabama at Birmingham; and the University of Illinois Urbana-Champaign.
Method of Research
Observational study
Subject of Research
People
Article Title
Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California
Article Publication Date
27-Sep-2024
