Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions.

Document Type

Article

Publication Date

7-2017

Identifier

DOI: 10.1016/j.jpeds.2017.03.046

Abstract

OBJECTIVE: To compare the timing and magnitude of variation of pediatric readmission rates across race/ethnicity for selected chronic conditions: asthma, diabetes, seizures, migraines, and depression.

STUDY DESIGN: Retrospective analysis of hospitalizations at 48 children's hospitals in the 2013 Pediatric Health Information System database for children (ages 0-18 years) admitted for asthma (n = 36 910), seizure (n = 35 361), diabetes (n = 12 468), migraine (n = 5882), and depression (n = 5132). Generalized linear models with a random effect for hospital were used to compare the likelihood of readmission by patients' race/ethnicity, adjusting for severity of illness, age, payer, and medical complexity. Adjusted readmission rates were calculated by week over 1 year.

RESULTS: Significant variation in adjusted readmission rates by race/ethnicity existed for conditions aside from depression. Disparities for diabetes and asthma emerged at 3 and 4 weeks, respectively; they remained divergent up to 1 year with the highest 1-year readmission rates in non-Hispanic blacks vs other race/ethnicities (diabetes: 21.7% vs 13.4%, P < .001; asthma: 21.4% vs 14.6%, P < .001). Disparities for migraines and seizure emerged at 6 and 7 weeks, respectively; they remained up to 1 year, with the highest 1-year readmission rates in non-Hispanic whites vs other race/ethnicities (migraine: 17.3% vs 13.6%, P < .001; seizure: 23.9% vs 21.9%, P < .001).

CONCLUSIONS: Readmission disparities behave differently across chronic conditions. They emerge more quickly after discharge for children hospitalized with asthma or diabetes than for seizures or migraines. The highest readmission rates were not consistently observed for 1 particular race/ethnicity. Study findings can impact pediatric chronic disease management to improve care for children with these conditions.

Journal Title

The Journal of pediatrics

Volume

186

First Page

158

Last Page

164

MeSH Keywords

Adolescent; Asthma; Child; Child, Preschool; Chronic Disease; Depressive Disorder; Diabetes Mellitus; Ethnic Groups; European Continental Ancestry Group; Female; Humans; Infant; Infant, Newborn; Male; Migraine Disorders; Patient Readmission; Retrospective Studies; Seizures; United States

Keywords

asthma; children; depression; diabetes; migraine; pediatrics; readmissions; seizures

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