Advertisement

Racial and ethnic disparities in emergency department wait times for children: analysis of a nationally representative cohort

Published:October 21, 2022DOI:https://doi.org/10.1016/j.acap.2022.10.013

      Abstract

      Objective

      : To evaluate the association of race and ethnicity with wait times for children in US emergency departments (ED).

      Methods

      : We performed a cross-sectional study of ED encounters of children (<18 years) from 2014-2019 using a multistage survey of nonfederal US ED encounters. Our primary variable of interest was composite race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and all others. Our outcome was ED wait time in minutes. We evaluated the association between race/ethnicity and wait time in Weibull regression models that sequentially added variables of acuity, demographics, hospital factors, and region/urbanicity.

      Results

      : We included 163,768,956 survey-weighted encounters. In univariable analysis, Hispanic children had a lower hazard ratio (HR) of progressing to evaluation (HR 0.84, 95% confidence interval [CI] 0.76-0.93) relative to NHW children, indicating longer ED wait times. This association persisted in serial multivariable models incorporating acuity, demographics, and hospital factors. This association was not observed when incorporating variables of hospital region and urbanicity (HR 0.91, 95% CI 0.83-1.00). In subgroup analysis, Hispanic ethnicity was associated with longer wait times in pediatric EDs (HR 0.76, 95% CI 0.63-0.92), non-metropolitan EDs (HR 0.75, 95% CI 0.64-0.89), and the Midwest region (HR 0.77, 95% CI 0.69-0.87). No differences in wait times were observed for children of Black race or other races.

      Conclusions

      : Hispanic children experienced longer ED wait times across serial multivariable models, with significant differences limited to pediatric, metropolitan, and Midwest EDs. These results highlight the presence of disparities in access to prompt emergency care for children.

      What's New

      : This muti-center study of US general and pediatric EDs demonstrates that Hispanic children experience longer ED wait times than non-Hispanic White children in multivariable analysis. In subgroup analysis, these findings were limited to pediatric, non-metropolitan, and Midwestern EDs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pines JM
        • Prabhu A
        • Hilton JA
        • Hollander JE
        • Datner EM.
        The effect of emergency department crowding on length of stay and medication treatment times in discharged patients with acute asthma.
        Acad Emerg Med. 2010; 17: 834-839
        • Bernstein SL
        • Aronsky D
        • Duseja R
        • et al.
        The effect of emergency department crowding on clinically oriented outcomes.
        Acad Emerg Med. 2009; 16: 1-10
        • Bhogal SK
        • McGillivray D
        • Bourbeau J
        • Benedetti A
        • Bartlett S
        • Ducharme FM.
        Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation.
        Ann Emerg Med. 2012; 60 (.e83): 84-91
        • Abdulkader ZM
        • Bali N
        • Vaz K
        • Yacob D
        • Di Lorenzo C
        • Lu PL.
        Predictors of Hospital Admission for Pediatric Cyclic Vomiting Syndrome.
        J Pediatr. 2021; 232: 154-158
        • Pines JM
        • Iyer S
        • Disbot M
        • Hollander JE
        • Shofer FS
        • Datner EM.
        The effect of emergency department crowding on patient satisfaction for admitted patients.
        Acad Emerg Med. 2008; 15: 825-831
        • Barbarian M
        • Bishop A
        • Alfaro P
        • et al.
        Patient-Reported Experience in the Pediatric Emergency Department: What Matters Most?.
        J Patient Saf. 2021; 17: e1166-e1170
        • Gorski JK
        • Mendonça EA
        • Showalter CD.
        The Impact of Diagnostic Decisions on Patient Experience in the Pediatric Emergency Department.
        Pediatr Emerg Care. 2021;
        • Fernandes CM
        • Price A
        • Christenson JM.
        Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician?.
        J Emerg Med. 1997; 15: 397-399
        • Arendt KW
        • Sadosty AT
        • Weaver AL
        • Brent CR
        • Boie ET.
        The left-without-being-seen patients: what would keep them from leaving?.
        Ann Emerg Med. 2003; 42: 317-323
        • Lu FQ
        • Hanchate AD
        • Paasche-Orlow MK.
        Racial/ethnic disparities in emergency department wait times in the United States, 2013-2017.
        Am J Emerg Med. 2021; 47: 138-144
        • Wu BU
        • Banks PA
        • Conwell DL.
        Disparities in emergency department wait times for acute gastrointestinal illnesses: results from the National Hospital Ambulatory Medical Care Survey, 1997-2006.
        Am J Gastroenterol. 2009; 104: 1668-1673
        • Johnson TJ
        • Goyal MK
        • Lorch SA
        • et al.
        Racial/Ethnic Differences in Pediatric Emergency Department Wait Times.
        Pediatr Emerg Care. 2022; 38: e929-e935
      1. About NAMCS/NHAMCS. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ahcd/about_ahcd.htm#NHAMCS. Updated December 30, 2021. Accessed January 10, 2022.

      2. HIPAA Privacy Rule Questions and Answers for NHAMCS. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ahcd/nhamcs_hipaa_privacy.htm. Updated June 16, 2021. Accessed January 10, 2022.

      3. 2010 Census Regions and Divisions of the United States. United States Census Bureau. https://www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html. Updated October 8, 2021. Accessed January 11, 2022.

      4. Metropolitan and Micropolitan. United States Census Bureau. https://www.census.gov/programs-surveys/metro-micro.html. Updated October 8, 2021. Accessed January 11, 2022.

      5. Emergency Severity Index (ESI): A Triage Tool for Emergency Departments. Agency for Healthcare Research and Quality,. https://www.ahrq.gov/patient-safety/settings/emergency-dept/esi.html. Updated May 2020. Accessed January 11, 2022.

        • Park CY
        • Lee MA
        • Epstein AJ.
        Variation in emergency department wait times for children by race/ethnicity and payment source.
        Health Serv Res. 2009; 44: 2022-2039
      6. Reliability of Estimates. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ahcd/ahcd_estimation_reliability.htm. Updated November 6, 20215. Accessed January 10, 2022.

        • James CA
        • Bourgeois FT
        • Shannon MW.
        Association of race/ethnicity with emergency department wait times.
        Pediatrics. 2005; 115: e310-e315
        • Olivarez GA
        • Pham PK
        • Liberman DB.
        The Effect of Language on the Discharge Process in a Pediatric Emergency Department.
        J Immigr Minor Health. 2017; 19: 1397-1403
        • Carrasquillo O
        • Orav EJ
        • Brennan TA
        • Burstin HR.
        Impact of language barriers on patient satisfaction in an emergency department.
        J Gen Intern Med. 1999; 14: 82-87
        • Schrader CD
        • Lewis LM.
        Racial disparity in emergency department triage.
        J Emerg Med. 2013; 44: 511-518