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Comparative Study
. 2023 Aug:259:113424.
doi: 10.1016/j.jpeds.2023.113424. Epub 2023 Apr 20.

Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis

Jeffrey I Campbell  1 , Kristen H Shanahan  2 , Melissa Bartick  3 , Mohsin Ali  4 , Don Goldmann  5 , Nadia Shaikh  6 , Sophie Allende-Richter  7
Affiliations
Comparative Study

Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis

Jeffrey I Campbell et al. J Pediatr. 2023 Aug.

Abstract

Objective: To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis.

Study design: Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile).

Results: We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11).

Conclusions: Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.

Keywords: health care disparities; osteomyelitis; pediatric.

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Conflict of interest statement

Conflict of interest disclosures: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Discharges included in the primary analysis.
Figure 2.
Figure 2.
Distribution of LOS by race/ethnicity. Circles represent discharges. Boxes represent median/IQR, and whiskers represent 90%ile range. Unweighted distributions are presented.
Online figure 3.
Online figure 3.
Predicted mean LOS by race and ethnicity, based on results from the main multivariable regression model.
See this image and copyright information in PMC

Comment in

  • Time to Rebalance the Plane.
    Hester GZ, Thornton A, Workman JK. Hester GZ, et al. J Pediatr. 2023 Sep;260:113558. doi: 10.1016/j.jpeds.2023.113558. Epub 2023 Jun 14. J Pediatr. 2023. PMID: 37321287 No abstract available.

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