title: Racial and economic disparity and the treatment of pediatric fractures.
abstract: Disparity in the treatment of various medical conditions in patient groups with differing racial and economic backgrounds has increasingly been reported. This paper examines the relationship between baseline racial and economic factors and the treatment of pediatric long-bone fractures. The 2000 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) was used to retrospectively examine the incidence and treatment of pediatric fractures. Data were included for supracondylar humerus (n = 2,957), femoral shaft (n = 1,726) or radius and ulna forearm fracture (n = 828) as their primary diagnosis were studied. Hispanic (78%) and black (82%) patients were more likely to receive closed reduction with internal fixation (percutaneous pinning) of supracondylar humerus fractures than whites (73%, P = 0.02). Despite a fairly large sample size, differences in treatment of supracondylar humerus fractures across primary payer or income groups were not statistically significant. Patients with femur fractures and private insurance were more likely to be treated with an external fixation device (7.2%) than patients in the Medicaid (3.8%) or self-pay (4.5%) groups (P = 0.015). No statistically significant difference was found in the treatment of forearm fractures across racial, primary payer or income groups. Racial and economic disparity is an important issue in medicine today. This study did demonstrate statistically significant differences in the treatment of pediatric supracondylar humerus across racial groups, with Blacks and Hispanics being more likely to receive percutaneous pinning of these injuries than Whites. Private insurance patients were also more likely to have femoral shaft fractures treated with an external fixator device than patients with Medicaid or self-pay as their primary payer. However, the clinical significance of these differences is not clear. Further research is needed to gain a more complete understanding of disparities in medicine, and their etiologies, in order to work towards optimizing the quality of medical care for all patient groups.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. james.d.slover@hitchcock.org
authors.forename: James
authors.initials: J
authors.lastname: Slover
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gibson
authors.forename: Tor
authors.initials: T
authors.lastname: Tosteson
authors.forename: Brian
authors.initials: B
authors.lastname: Smith
authors.forename: Kenneth
authors.initials: K
authors.lastname: Koval
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005264:Femoral Fractures / Q000208:ethnology / Q000628:therapy*; D017048:Health Care Costs; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000208:ethnology / Q000628:therapy*; D007182:Income; D007348:Insurance, Health / Q000191:economics; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data