Hospital pediatrics · 2026
Racial and Ethnic Disparities in Length of Stay for Pediatric Bacterial Tracheostomy-Associated Infections.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Rush Margaret, Moffet Ilana, Kono Naoko, Hahn Andrea, Morrison John M, Thomson Joanna, Cogen Jonathan D, Forster Catherine S, Neely Michael, Hofman DeYoung Sarah, Mairal Sukhada V, Mack Wendy J, Simon Tamara D, Russell Christopher J, Pediatric Research in Inpatient Setting Network
Аннотация
BACKGROUND AND OBJECTIVES: Racial and ethnic disparities disproportionately impact children with medical complexity (CMC), including children with tracheostomies. Children hospitalized for bacterial tracheostomy-associated infections (bTRAINs) experience care variations that may exacerbate disparities. Our study aimed to quantify disparities in length of stay (LOS) for children hospitalized with bTRAINs.
METHODS: We conducted a multicenter observational study of children aged 0 to 21 years who were hospitalized and treated for a bTRAIN at 6 children's hospitals between August 2020 and August 2024, excluding children with outlier LOS (>30 days). Our primary predictor was race and ethnicity, as documented in the electronic medical record. Our primary outcome was LOS (days). We used mixed-effects regression modeling to account for repeated encounters, nesting of patients within hospitals, and adjusting for confounders (socioeconomic factors, comorbidities and illness severity).
RESULTS: We included 662 children (39% white, 35% Hispanic, 22% Black, and 4% Asian) representing 1349 unique encounters. The median age at hospitalization was 6 years (IQR 2-13) and 72% of children had public insurance. Median LOS was 8 days (IQR 5-12). When adjusting for confounders, all other racial groups had longer LOS compared with white children with ratio of means of 1.14 (95% CI: 1.03-1.28) for Black; 1.12 (95% CI: 1.01-1.25) for Hispanic; and 1.29 (95% CI: 1.07-1.54) for Asian children.
CONCLUSIONS: Black, Hispanic, and Asian children hospitalized for a bTRAIN experience longer LOS than white children. Understanding is needed on how implicit bias, systemic racism, and care-team preferences lead to disparities and if standardized care can improve outcomes.
METHODS: We conducted a multicenter observational study of children aged 0 to 21 years who were hospitalized and treated for a bTRAIN at 6 children's hospitals between August 2020 and August 2024, excluding children with outlier LOS (>30 days). Our primary predictor was race and ethnicity, as documented in the electronic medical record. Our primary outcome was LOS (days). We used mixed-effects regression modeling to account for repeated encounters, nesting of patients within hospitals, and adjusting for confounders (socioeconomic factors, comorbidities and illness severity).
RESULTS: We included 662 children (39% white, 35% Hispanic, 22% Black, and 4% Asian) representing 1349 unique encounters. The median age at hospitalization was 6 years (IQR 2-13) and 72% of children had public insurance. Median LOS was 8 days (IQR 5-12). When adjusting for confounders, all other racial groups had longer LOS compared with white children with ratio of means of 1.14 (95% CI: 1.03-1.28) for Black; 1.12 (95% CI: 1.01-1.25) for Hispanic; and 1.29 (95% CI: 1.07-1.54) for Asian children.
CONCLUSIONS: Black, Hispanic, and Asian children hospitalized for a bTRAIN experience longer LOS than white children. Understanding is needed on how implicit bias, systemic racism, and care-team preferences lead to disparities and if standardized care can improve outcomes.