TY - JOUR
T1 - Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants
AU - Gutman, Colleen K.
AU - Aronson, Paul L.
AU - Singh, Nidhi V.
AU - Pickett, Michelle L.
AU - Bouvay, Kamali
AU - Green, Rebecca S.
AU - Roach, Britta
AU - Kotler, Hannah
AU - Chow, Jessica L.
AU - Hartford, Emily A.
AU - Hincapie, Mark
AU - St. Pierre-Hetz, Ryan
AU - Kelly, Jessica
AU - Sartori, Laura
AU - Hoffmann, Jennifer A.
AU - Corboy, Jacqueline B.
AU - Bergmann, Kelly R.
AU - Akinsola, Bolanle
AU - Ford, Vanessa
AU - Tedford, Natalie J.
AU - Tran, Theresa T.
AU - Gifford, Sasha
AU - Thompson, Amy D.
AU - Krack, Andrew
AU - Piroutek, Mary Jane
AU - Lucrezia, Samantha
AU - Chung, Sunhee
AU - Chowdhury, Nabila
AU - Jackson, Kathleen
AU - Cheng, Tabitha
AU - Pulcini, Christian D.
AU - Kannikeswaran, Nirupama
AU - Truschel, Larissa L.
AU - Lin, Karen
AU - Chu, Jamie
AU - Molyneaux, Neh D.
AU - Duong, Myto
AU - Dingeldein, Leslie
AU - Rose, Jerri A.
AU - Theiler, Carly
AU - Bhalodkar, Sonali
AU - Powers, Emily
AU - Waseem, Muhammad
AU - Lababidi, Ahmed
AU - Yan, Xinyu
AU - Lou, Xiang Yang
AU - Fernandez, Rosemarie
AU - Lion, K. Casey
N1 - Publisher Copyright:
© 2024 American Medical Association. All rights reserved.
PY - 2024/1/2
Y1 - 2024/1/2
N2 - Importance: Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. Objective: To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. Design, Setting, and Participants: This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Exposures: Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). Main Outcomes and Measures: The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Results: Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Conclusions and Relevance: Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity..
AB - Importance: Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. Objective: To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. Design, Setting, and Participants: This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Exposures: Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). Main Outcomes and Measures: The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Results: Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Conclusions and Relevance: Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity..
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U2 - 10.1001/jamapediatrics.2023.4890
DO - 10.1001/jamapediatrics.2023.4890
M3 - Article
C2 - 37955907
AN - SCOPUS:85179721582
SN - 2168-6203
VL - 178
SP - 55
EP - 64
JO - JAMA Pediatrics
JF - JAMA Pediatrics
IS - 1
ER -