Examining Disparities in Pediatric Asthma, Pneumonia, and Bronchiolitis Care in General Hospitals

BACKGROUND/OBJECTIVE Prior disparity research has focused on evaluating patient outcomes in freestanding children’s hospitals, rather than identifying potential drivers of these disparities. Our objective was to evaluate drivers of disparities in respiratory illness care quality and outcomes in a national sample of general hospitals. METHODS This retrospective study used pretrial data from hospitals in the SIP trial (Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children, NCT05206695). Patients were eligible if they had a primary diagnosis of asthma, pneumonia, or bronchiolitis and were admitted during 3 winter periods (2019–2022). We evaluated quality measures/adherence to evidence-based practices and patient outcomes (length of stay, intensive care unit ICU transfer, and hospital readmission/emergency department ED revisit within 30 days). Multilevel regression models were used to evaluate disparities by race and ethnicity, primary insurance, and preferred language. RESULTS A total of 3188 admissions from 33 hospitals were analyzed. Quality measure adherence was 30% to 89%. Children with asthma on public insurance were more likely to receive recommended discharge prescriptions of inhaled corticosteroids than those on private insurance (77% vs 70%; odds ratio OR, 1.87 95% CI, 1. 12–3.12). Children with public insurance admitted for asthma had higher risk of ICU transfer (adjusted OR AOR, 1.93 95% CI, 1.01–3.72) and 30-day readmissions/ED revisits (AOR, 2.72 95% CI, 1.37–5.39). Hispanic children admitted for asthma had higher risk of 30-day readmissions/ED revisits compared with white children (AOR, 2.37 95% CI, 1.08–5.22). CONCLUSIONS In this national analysis of children admitted to general hospitals, we found disparities in outcomes for children with asthma who were on public insurance or Hispanic.