Examining black and white racial disparities in emergency department consultations by age and gender

https://doi.org/10.1016/j.ajem.2021.01.095Get rights and content

Highlights

  • White and black adult patients receive similar numbers of ED consultations.

  • Black and white adult patients had the same risk of receiving consultations.

  • White adult females have a higher risk of receiving consultations.

  • Black and white pediatric patients had the same risk of receiving consultations.

  • White pediatric males have a higher risk of receiving a specialty consultation.

Abstract

Background

While significant racial inequities in health outcomes exist in the United States, these inequities may also exist in healthcare processes, including the Emergency Department (ED). Additionally, gender has emerged in assessing racial healthcare disparity research. This study seeks to determine the association between race and the number and type of ED consultations given to patients presenting at a safety-net, academic hospital, which includes a level-one trauma center.

Method

Retrospective data was collected on the first 2000 patients who arrived at the ED from 1/1/2015–1/7/2015, with 532 patients being excluded. Of the eligible patients, 77% (74.6% adults and 80.7% pediatric patients) were black and 23% (25.4% adults and 19.3% pediatric patients) were white.

Results

White and black adult patients receive similar numbers of ED consultations and remained after gender stratification. White pediatric males have a 91% higher incidence of receiving an ED consultation in comparison to their white counterparts. No difference was found between black and white adult patients when assessing the risk of receiving consultations. White adult females have a 260% higher risk of receiving both types of consultations than their black counterparts. Black and white pediatric patients had the same risk of receiving consultations, however, white pediatric males have a 194% higher risk of receiving a specialty consultation as compared to their white counterparts.

Discussion

Future work should focus on both healthcare practice improvements, as well as explanatory and preventive research practices. Healthcare practice improvements can encompass development of appropriate racial bias trainings and institutionalization of conversations about race in medicine.

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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