Is there a racial disparity in RSV or bronchiolitis hospitalization?
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Racial Disparities in RSV and Bronchiolitis Hospitalization
Introduction
Respiratory syncytial virus (RSV) and bronchiolitis are significant causes of hospitalization among infants and young children. Recent studies have highlighted potential racial and ethnic disparities in hospitalization rates and management of these conditions. This article synthesizes findings from multiple research papers to provide a comprehensive overview of these disparities.
Incidence of RSV and Bronchiolitis Hospitalization by Race and Ethnicity
Higher Hospitalization Rates Among Minority Groups
Research indicates that there are notable racial and ethnic disparities in the incidence of hospitalizations for RSV and bronchiolitis. A study conducted in New York found that non-Hispanic black and Hispanic infants had significantly higher hospitalization rates for bronchiolitis compared to non-Hispanic white and Asian infants. Specifically, the cumulative incidence was 15.4 per 1000 births for non-Hispanic black infants and 19.1 per 1000 births for Hispanic infants, compared to 8.6 per 1000 births for non-Hispanic white infants and 6.5 per 1000 births for Asian infants.
Disparities in the United States
In the United States, black children under five years of age were found to have higher hospitalization rates for acute respiratory illness (ARI) and influenza compared to white children. For RSV, the rates were similar among black and white children under 12 months, but higher for black children aged 12 months or more. This suggests that racial disparities in RSV hospitalization rates become more pronounced as children age.
Socioeconomic Factors and Health Care Utilization
Influence of Socioeconomic Status
Socioeconomic factors play a significant role in the observed disparities. In Israel, a study comparing Arab and Jewish children found that Arab patients were generally younger, had younger parents, and lived in lower socioeconomic status towns. Despite these differences, the severity of RSV bronchiolitis did not differ significantly between the two groups. This suggests that socioeconomic status and related factors, rather than ethnicity alone, may influence hospitalization rates.
Insurance and Access to Care
In the United States, black children were more likely to have public insurance or no insurance compared to white children, which could impact their access to healthcare and subsequent hospitalization rates. This disparity in insurance coverage highlights the need for improved healthcare access and equity.
Differences in Management and Treatment
Variations in Treatment Practices
Studies have also identified differences in the management and treatment of bronchiolitis across racial and ethnic groups. For instance, non-Hispanic black children were more likely to receive albuterol before admission and less likely to receive chest x-rays during hospitalization compared to other groups. Hispanic children were more likely to be discharged on inhaled corticosteroids. These variations in treatment practices suggest potential deviations from standardized care guidelines, which could contribute to disparities in health outcomes.
Need for Standardized Care Pathways
The observed differences in treatment practices underscore the importance of implementing standardized care pathways for bronchiolitis. Such pathways could help ensure that all children receive consistent and evidence-based care, regardless of their racial or ethnic background.
Conclusion
Racial and ethnic disparities in RSV and bronchiolitis hospitalization rates and management are evident from multiple studies. Minority groups, particularly non-Hispanic black and Hispanic children, experience higher hospitalization rates and variations in treatment practices. Socioeconomic factors and healthcare access play crucial roles in these disparities. Addressing these issues through targeted public health interventions and standardized care pathways is essential to reduce these disparities and improve health outcomes for all children.
Sources and full results
Most relevant research papers on this topic
Comparisons between ethnic groups in hospitalizations for respiratory syncytial virus bronchiolitis in Israel
Disparities between black and white children in hospitalizations associated with acute respiratory illness and laboratory-confirmed influenza and respiratory syncytial virus in 3 US counties--2002-2009.
Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals
Racial/Ethnic Disparity in the Incidence of Bronchiolitis Requiring Hospitalization.
Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009–2019: A Study of the National (Nationwide) Inpatient Sample
Racial/ethnic differences in the presentation and management of severe bronchiolitis.
2625. Incidence of Bronchiolitis Requiring Hospitalization in the First 2 years of Life Among Healthy Term Infants with Different Races/Ethnicities: A Population-based Longitudinal Study
Racial Disparities in ICU Outcomes: A Systematic Review*
Socioeconomic position, bronchiolitis and asthma in children: counterfactual disparity measures from a national birth cohort study
Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia.
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