title: Racial differences in antibiotic prescribing by primary care pediatricians.
abstract: OBJECTIVE
  To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician.
  
  
  METHODS
  Retrospective cohort study of 1,296,517 encounters by 208,015 children to 222 clinicians in 25 practices in 2009. Clinical, antibiotic prescribing, and demographic data were obtained from a shared electronic health record. We estimated within-clinician associations between patient race (black versus nonblack) and (1) antibiotic prescribing or (2) acute respiratory tract infection diagnosis after adjusting for potential patient-level confounders.
  
  
  RESULTS
  Black children were less likely to receive an antibiotic prescription from the same clinician per acute visit (23.5% vs 29.0%, odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.72-0.77) or per population (0.43 vs 0.67 prescriptions/child/year, incidence rate ratio 0.64; 95% CI 0.63-0.66), despite adjustment for age, gender, comorbid conditions, insurance, and stratification by practice. Black children were also less likely to receive diagnoses that justified antibiotic treatment, including acute otitis media (8.7% vs 10.7%, OR 0.79; 95% CI 0.75-0.82), acute sinusitis (3.6% vs 4.4%, OR 0.79; 95% CI 0.73-0.86), and group A streptococcal pharyngitis (2.3% vs 3.7%, OR 0.60; 95% CI 0.55-0.66). When an antibiotic was prescribed, black children were less likely to receive broad-spectrum antibiotics at any visit (34.0% vs 36.9%, OR 0.88; 95% CI 0.82-0.93) and for acute otitis media (31.7% vs 37.8%, OR 0.75; 95% CI 0.68-0.83).
  
  
  CONCLUSIONS
  When treated by the same clinician, black children received fewer antibiotic prescriptions, fewer acute respiratory tract infection diagnoses, and a lower proportion of broad-spectrum antibiotic prescriptions than nonblack children. Reasons for these differences warrant further study.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, 3535 Market St, Ste 1518, Philadelphia, PA 19104, USA. gerberj@email.chop.edu
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.forename: Priya A
authors.initials: PA
authors.lastname: Prasad
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.forename: Robert W
authors.initials: RW
authors.lastname: Grundmeier
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.forename: Richard C
authors.initials: RC
authors.lastname: Wasserman
authors.forename: David M
authors.initials: DM
authors.lastname: Rubin
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001741:Black or African American; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D012189:Retrospective Studies; D044465:White People
chemical_list: D000900:Anti-Bacterial Agents