Racial disparities in readmission, complications, and procedures in children with Crohn's disease.
Racial disparities in readmission, complications, and procedures in children with Crohn's disease.
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DOI：
10.1097/mib.0000000000000325
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发表时间：
2015-04
影响因子：
4.9
通讯作者：
Crandall WV
中科院分区：
文献类型：
--
作者：
Dotson JL;Kappelman MD;Chisolm DJ;Crandall WV
护理和预后方面的种族差异导致儿童死亡率和发病率，但在儿童克罗恩病(CD)中的作用尚不清楚。在这项研究中，我们比较了黑人和白人儿童与CD的队列，以确定种族与美国住院患者在再入院、并发症和程序方面的差异的程度。数据摘自儿科健康信息系统(2004年1月1日-2012年6月30日)，数据来自≤21岁因诊断为CD而住院的患者。白人和黑人队列由医院以2：1的比例随机选择。主要结果是从指标出院到再次入院的时间。最常见的并发症和操作按RACE进行评估。共有4377名患者。与白人儿童相比，黑人儿童首次重新入院的时间更短，再次入院的概率更高(p=0.009)，再次入院的风险增加了16%(p=0.10)。黑人儿童的住院时间更长，重新入院的频率也更高(出院后30天-12个月)(p<；0.001)。在指数住院期间，更多的黑人儿童有肛周疾病和贫血(p<；0.001)。在任何住院期间，黑人儿童的肛周疾病、贫血和维生素D缺乏的发生率更高，肛周手术、内窥镜检查和输血的次数更多(p<；0.001)。与种族有关的住院儿童在重新入院、并发症和程序方面存在差异。目前尚不清楚这些差异是由于遗传差异、更严重的内源性疾病、坚持治疗、获得治疗还是治疗差异所致。
Racial disparities in care and outcomes contribute to mortality and morbidity in children however the role in pediatric Crohn’s disease (CD) is unclear. In this study, we compared cohorts of Black and White children with CD to determine the extent race is associated with differences in readmissions, complications, and procedures among hospitalizations in the United States. Data were extracted from the Pediatric Health Information System (January 1, 2004–June 30, 2012) for patients ≤21 years of age hospitalized with a diagnosis of CD. White and Black cohorts were randomly selected in a 2:1 ratio by hospital. The primary outcome was time from index hospital discharge to readmission. The most frequent complications and procedures were evaluated by race. There were 4377 patients. Black children had a shorter time to first readmission and higher probability of readmission (p=0.009), and a 16% increase in risk of readmission compared to White children (p=0.01). Black children had longer length of stay and higher frequency of overall and late (30 days–12 months post discharge) readmissions (p<0.001). During index hospitalization, more Black children had perianal disease and anemia (p<0.001). During any hospitalization, Black children had higher incidence of perianal disease, anemia, and vitamin D deficiency, and greater number of perianal procedures, endoscopies, and blood product transfusion (p<0.001). There are differences in hospital readmissions, complications, and procedures among hospitalized children related to race. It is unclear whether these differences are due to genetic differences, worse intrinsic disease, adherence, access to treatment, or treatment disparities.