Disparities Exist by Race and Payer in Pediatric Emergency Chest Pain Treatment

Monday, October 19, 2009

African-American children and children without private insurance are less likely than Caucasian children or those with private insurance to be tested when they come to the emergency department complaining of chest pain.

A new Cincinnati Children’s Hospital Medical Center study shows that 71 percent of Caucasian children receive either an EKG, chest X-ray or a complete blood count. Only 59 percent of African-American children receive any of these tests. Similarly, 75 percent of children with private insurance receive at least one of these heart tests, while 59 percent of those on Medicaid or another public plan are tested.

These results hold true even when adjusted for age, gender or metro area, according to John Hambrook, MD, a pediatric cardiologist and the study’s main author. The study will be presented at 5 pm Eastern time Friday, Oct. 16, at the annual meeting of the American Academy of Pediatrics in Washington, D.C.

"These new findings are significant because they present a nationwide practice of allowing non-clinical data to guide emergency care of our vulnerable pediatric population, proving a different standard of care depending on one's race or insurance type," says Tom Kimball, MD, a pediatric cardiologist in the Heart Institute at Cincinnati Children’s and senior author of the study. "This does not necessarily mean that an increased level of testing implies better or more appropriate care. That conclusion would be beyond the scope of this study."

The researchers studied five years of data from the National Hospital Ambulatory Medical Care Survey between 2002 and 2006. That survey was designed to be representative of the entire United States population. The researchers studied children and teens who came to the emergency department with a primary complain of chest pain. The 818 emergency visits represented more than 2.5 million visits nationwide.

The Caucasian children were 1.6 times more likely to receive testing than African-American children, and patients with private insurance were 2.2 times more likely to receive testing than those with government insurance.

Dr. Hambrook conducted the study during a fellowship at Cincinnati Children’s. He is currently at the Children’s Hospital of Wisconsin in Milwaukee. Other researchers included James Cnota, MD, a pediatric cardiologist, and Phil Khoury, MS, both with the Heart Institute.