Geography and age drive racial and ethnic disparities in hospital mortality for paediatric community-acquired pneumonia in the United States: a retrospective population based cohort study of hospitalized patients
Abstract
Summary Background Racial disparities in the outcomes of adult community-acquired pneumonia are well described. However, the presence of racial and ethnic disparities in paediatric community-acquired pneumonia and the mechanisms underlying these disparities remain unclear. Motivated by disparities related to age and geography in paediatric sepsis, we evaluated the association between the joint exposure of race/ethnicity, age, and geographic region and mortality for community-acquired pneumonia to provide opportunities for assessment of future interventions that provide equitable healthcare. We hypothesized that geographic region and age would inform the association between race or ethnicity and mortality in community-acquired pneumonia. Methods This was a retrospective cohort study of children age < 18 years with community-acquired pneumonia hospitalized between 2016 and 2021 in the Public Health Information System (PHIS) database. Models included a priori stratification of age ≤ 1 year and geographic region. Racial and ethnic groups (White, Black, Hispanic/Latino, and Other), four geographic regions (Northeast, South, Midwest, or West), and two age categories (<1 and ≥1 year) were combined to create a joint exposure variable. Multivariable logistic regression, clustered by hospital and adjusting for sex, primary insurance payer, median household income quartile, urban identification, and the presence of a complex chronic condition(s), quantified the relationship between the…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 783,744 participants or records.
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