Examining black and white racial disparities in emergency department consultations by age and gender
Section snippets
Background
Racial health disparity research in the United States demonstrates significant inequities in health outcomes — black patients experience greater rates of premature death due to stroke and coronary heart disease, eight times higher HIV death rates, and two times higher infant mortality and diabetes death rates than their white counterparts [[1], [2], [3]]. While an understanding of health outcomes disparities is important, research has also begun to explore racial disparities in healthcare
Study design
This was a retrospective study. Data collection occurred in two phases, modeled on our prior study examining health disparities in the inpatient setting [27]. data was extracted from the hospital data warehouse and this was followed by manual chart review. Consultations were identified in the ‘Notes’ section of ‘Chart Review’ in each patients' Electronic Medical Record (EMR). Only the notes between the patient's ED presentation and discharge date were screened. ED consultations were determined
Demographics
The remaining 1468 patients were analyzed, 77% of which were black and 23% of which were white. Among the 913 analyzed adult patients, 25.4% were white and 74.6% were black. Among the 555 analyzed pediatric patients, 19.3% were white and 80.7% were black. (See Table 1).
As shown in Table 1, white adult patients presenting at the ED were significantly older (p < 0.001), more likely to receive lower triage (higher acuity) scores (p = 0.009), more likely to be admitted to inpatient (p = 0.003), and
Discussion
This is the first study to our knowledge that assesses all types of ED consultations, thereby shedding light on ED quality of care that impacts all patients presenting to this ED. This study's allows for an understanding of the general, yet frequent process of ED consultation that can be modified to augment equity in the future.
While we hypothesized that black patients evaluated in the ED received significantly fewer consultations, we found that this only held true for black adult females and
Funding
None.
Author contributions statement
RWS: Conceptualization; Data curation; Methodology; Supervision; Validation; Visualization; Writing - review & editing. MS Conceptualization; Funding acquisition; Investigation; Methodology; Visualization; Writing - review & editing. AB: Data curation; Project administration; Resources; Software; Validation; Visualization; Writing - review & editing. DRB: Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Validation; Writing - original draft; Writing - review &
Declaration of Competing Interest
None.
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2024, The Lancet Child and Adolescent Health