Racial and ethnic differences in antibiotic use for viral illness in emergency departments

Monika K. Goyal, Tiffani J. Johnson, James M. Chamberlain, T. Charles Casper, Timothy Simmons, Evaline A. Alessandrini, Lalit Bajaj, Robert W. Grundmeier, Jeffrey S. Gerber, Scott A. Lorch, Elizabeth R. Alpern

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED. METHODS: This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site. RESULTS: Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6% (95% confidence interval [CI] 2.4%-2.8%) received antibiotics, including 4.3% of non-Hispanic (NH) white, 1.9% of NH black, 2.6% of Hispanic, and 2.9% of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36-0.53), Hispanic (aOR 0.65; CI 0.53-0.81), and other NH (aOR 0.68; CI 0.52-0.87) children remained less likely to receive antibiotics for viral ARTIs. CONCLUSIONS: Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.

Original languageEnglish (US)
Article numbere20170203
JournalPediatrics
Volume140
Issue number4
DOIs
StatePublished - Oct 2017
Externally publishedYes

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Respiratory Tract Infections
Hospital Emergency Service
Anti-Bacterial Agents
Pediatrics
Hispanic Americans
Confidence Intervals
Odds Ratio
Triage
Emergency Medical Services
Insurance
Registries
Primary Health Care
Chronic Disease
Cohort Studies
Retrospective Studies
Logistic Models
Health
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Casper, T. C., Simmons, T., Alessandrini, E. A., ... Alpern, E. R. (2017). Racial and ethnic differences in antibiotic use for viral illness in emergency departments. Pediatrics, 140(4), [e20170203]. https://doi.org/10.1542/peds.2017-0203

Racial and ethnic differences in antibiotic use for viral illness in emergency departments. / Goyal, Monika K.; Johnson, Tiffani J.; Chamberlain, James M.; Casper, T. Charles; Simmons, Timothy; Alessandrini, Evaline A.; Bajaj, Lalit; Grundmeier, Robert W.; Gerber, Jeffrey S.; Lorch, Scott A.; Alpern, Elizabeth R.

In: Pediatrics, Vol. 140, No. 4, e20170203, 10.2017.

Research output: Contribution to journalArticle

Goyal, MK, Johnson, TJ, Chamberlain, JM, Casper, TC, Simmons, T, Alessandrini, EA, Bajaj, L, Grundmeier, RW, Gerber, JS, Lorch, SA & Alpern, ER 2017, 'Racial and ethnic differences in antibiotic use for viral illness in emergency departments', Pediatrics, vol. 140, no. 4, e20170203. https://doi.org/10.1542/peds.2017-0203
Goyal MK, Johnson TJ, Chamberlain JM, Casper TC, Simmons T, Alessandrini EA et al. Racial and ethnic differences in antibiotic use for viral illness in emergency departments. Pediatrics. 2017 Oct;140(4). e20170203. https://doi.org/10.1542/peds.2017-0203
Goyal, Monika K. ; Johnson, Tiffani J. ; Chamberlain, James M. ; Casper, T. Charles ; Simmons, Timothy ; Alessandrini, Evaline A. ; Bajaj, Lalit ; Grundmeier, Robert W. ; Gerber, Jeffrey S. ; Lorch, Scott A. ; Alpern, Elizabeth R. / Racial and ethnic differences in antibiotic use for viral illness in emergency departments. In: Pediatrics. 2017 ; Vol. 140, No. 4.
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abstract = "BACKGROUND AND OBJECTIVES: In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED. METHODS: This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site. RESULTS: Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6{\%} (95{\%} confidence interval [CI] 2.4{\%}-2.8{\%}) received antibiotics, including 4.3{\%} of non-Hispanic (NH) white, 1.9{\%} of NH black, 2.6{\%} of Hispanic, and 2.9{\%} of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36-0.53), Hispanic (aOR 0.65; CI 0.53-0.81), and other NH (aOR 0.68; CI 0.52-0.87) children remained less likely to receive antibiotics for viral ARTIs. CONCLUSIONS: Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.",
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AU - Goyal, Monika K.

AU - Johnson, Tiffani J.

AU - Chamberlain, James M.

AU - Casper, T. Charles

AU - Simmons, Timothy

AU - Alessandrini, Evaline A.

AU - Bajaj, Lalit

AU - Grundmeier, Robert W.

AU - Gerber, Jeffrey S.

AU - Lorch, Scott A.

AU - Alpern, Elizabeth R.

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N2 - BACKGROUND AND OBJECTIVES: In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED. METHODS: This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site. RESULTS: Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6% (95% confidence interval [CI] 2.4%-2.8%) received antibiotics, including 4.3% of non-Hispanic (NH) white, 1.9% of NH black, 2.6% of Hispanic, and 2.9% of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36-0.53), Hispanic (aOR 0.65; CI 0.53-0.81), and other NH (aOR 0.68; CI 0.52-0.87) children remained less likely to receive antibiotics for viral ARTIs. CONCLUSIONS: Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.

AB - BACKGROUND AND OBJECTIVES: In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED. METHODS: This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site. RESULTS: Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6% (95% confidence interval [CI] 2.4%-2.8%) received antibiotics, including 4.3% of non-Hispanic (NH) white, 1.9% of NH black, 2.6% of Hispanic, and 2.9% of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36-0.53), Hispanic (aOR 0.65; CI 0.53-0.81), and other NH (aOR 0.68; CI 0.52-0.87) children remained less likely to receive antibiotics for viral ARTIs. CONCLUSIONS: Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.

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