Investigating Race, Insurance and ED Visits in Pediatric Crohn’s Disease
Jennifer Dotson, MD, MPH, Principal Investigator, Center for Innovation in Pediatric Practice
In what may be the first nationally representative study evaluating the impact of race and insurance status on emergency department treatment for Crohn’s disease, a team from Nationwide Children’s Hospital found that black children and those insured by Medicaid make more repeat visits and receive somewhat fewer treatments than white and privately insured peers.
But in contrast to earlier literature demonstrating disparities in the kind of treatments received, adjusted analyses found no significant differences in the use of imaging, laboratory testing and medication among the populations. Small treatment differences were found when analyzing race and payor status separately, but controlling for one of those variables often mitigated the differences found with the other.
The study was published in Inflammatory Bowel Diseases.
“We did not always find that race or insurance explains differences in treatments for these patients with Crohn’s disease,” says Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children’s and principal investigator in the Center for Innovation in Pediatric Practice. “We did find in some cases that there are fewer treatments for black children than white children, or for children with Medicaid than children with private insurance, but there are likely larger socioeconomic forces at work.”
Among the possible explanations: children with lower socioeconomic status may use emergency services for routine care more frequently, receiving fewer services per emergency department visit, the authors suggest.
The study included records of 2,168 children with a diagnosis of Crohn’s disease; 77% were white and 23% were black. They made a total of 3,779 visits at 38 hospitals. White children were more likely to have private insurance and have a higher median neighborhood income.
Among children with repeat visits, 33% were black, 22% white; 27% had Medicaid, 21% private insurance. The findings highlight the need for strategies that address emergency department use for all patients, especially for those who do not have optimal access to health care, the authors write.
“We need to use this opportunity for better outpatient management of children with IBD, assuring that everyone receives the appropriate care when they need it, and that non-emergent problems are more effectively handled in the office setting,” says Dr. Dotson.
CITATION:
Dotson JL, Kappelman MD, Bricker J, Andridge R, Chisolm DJ, Crandall WV. Multicenter Evaluation of Emergency Department Treatment for Children and Adolescents with Crohn’s Disease according to Race/Ethnicity and Insurance Payor Status. Inflammatory Bowel Diseases. 2019 Jan 1;25(1):194-203.
