title: Race, otitis media, and antibiotic selection.
abstract: OBJECTIVE
  Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally.
  
  
  METHODS
  We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM.
  
  
  RESULTS
  The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).
  
  
  CONCLUSIONS
  Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; keflemi@emory.edu.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Fleming-Dutra
authors.affiliation: School of Medicine, University of California, San Francisco, California;
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Shapiro
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.affiliation: Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
mesh_terms: D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D044383:Black People / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006306:Health Surveys / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007223:Infant; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D033282:Parental Consent / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D000658:Amoxicillin
keywords: NAMCS; NHAMCS; antibiotic use; children; otitis media; pediatric