Disparities in Hospital Length of Stay and Morbidity in Acute Care Pediatric Cardiology Patients

Abstract

BACKGROUND Multicenter collaborative studies examining disparities in in-hospital outcomes are lacking in pediatric cardiology. We hypothesized that Black and Hispanic patients in pediatric acute care cardiology units (ACCUs) have increased length of stay (LOS) and complications compared with their counterparts. METHODS Utilizing the Pediatric Acute Care Cardiology Collaborative registry, we examined ACCU hospitalizations from January 2, 2019, to July 30, 2021. Hospitalizations were categorized by race and ethnicity and subcategorized by region. Differences in LOS and mean total number of complications were assessed using Wilcoxon rank sum and Kruskal-Wallis testing. Generalized linear models were constructed to evaluate differences between regions, race, and ethnicity. Multiple testing correction was performed which established a significance threshold of .001. RESULTS Analysis included 29 079 hospitalizations from 28 centers. Patients identifying as non-Hispanic (NH) Black (median, 5.0 [IQR, 3.0–13.0]) and NH other (6.0 [3.0–15.0]) had longer LOS than NH white patients (5.0 [IQR, 2.0–11.0]; P < .0001). Hispanic patients had a shorter LOS than NH patients (median, 5.0 [IQR, 2.0–11.0] vs 6.0 [3.0–14.0]; P < .0001). The number of complications was significantly higher for patients who identify as NH Black or NH other compared with NH white patients. The gaps between LOS and complications persisted in US regions with some areas demonstrating greater difference: LOS difference for NH Black patients was more pronounced in the West than in the Northeast (median, 5.5 [IQR, 3.0–15.0] vs 5.0 [2.0–12.0]). For Hispanic patients in the South, LOS and complications were lower compared with those in the West and the Northeast. CONCLUSION Significant racial and ethnic disparities exist in hospital LOS and complications in pediatric cardiology, with some regions of the United States demonstrating greater disparity than others.