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Black children were less likely to be diagnosed with otitis media and more likely to be prescribed narrow-spectrum, rather than broad-spectrum, antibiotics compared with nonblack children, according to a recent study.
“These findings raise concerns that differences in care for otitis media based on race may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children,” wrote Dr. Katherine E. Fleming-Dutra of Emory University, Atlanta (Pediatrics 2014 [doi:10.1542/peds.2014-1781]).
After a study in the Philadelphia area showed lower otitis media diagnosis rates and less use of
broad-spectrum antibiotics for blacks compared with nonblacks, these researchers investigated race, diagnosis, and prescribing patterns nationwide.
They analyzed visits for children 14 years old and younger between 2008 and 2010 using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both data sets from the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Based on 4,178 visits in the database, the researchers estimated that 19.2 million visits for otitis media occurred from 2008 to 2010 in the United States. However, only 7% of black children’s visits included an otitis media diagnosis, compared with 10% of nonblack children’s visits (P = .004).
While black and nonblack children with otitis media were prescribed antibiotics at similar rates (81% vs. 76%, respectively, P = .30), black children were prescribed broad-spectrum antibiotics 42% of the time, compared with 52% for nonblack children (P = .01). Broad-spectrum cephalosporins were prescribed for otitis media for 12% of black children and 21% of nonblack children; broad-spectrum penicillins were prescribed for 10% of black children and 16% of nonblack children with otitis media.
After adjustment for age, gender, region, insurance, care setting, metropolitan area, and year, black children had 41% lower odds than did nonblack children of receiving a broad-spectrum antibiotic prescription for otitis media.
The study was funded by the CDC. Dr. Gerber and Dr. Hersh received a Pfizer research grant to implement antibiotic stewardship in children’s hospitals. The remaining authors had no relevant financial disclosures.
“At face value, these data could indicate a ‘reversal’ in direction of the health care disparity usually identified in the United States. Fleming-Dutra et al. found no differences in care-seeking by black children versus nonblack children for upper respiratory tract conditions, suggesting that the difference in prescribing for acute otitis media was not due to differences in care-seeking behaviors among the families of black and nonblack children.
“We as physicians may enter the patient-provider relationship with our own set of biases, stereotypes, and expectations. We may subconsciously use the strategy of socialization to put people into categories (i.e., race) to use cognitive shortcuts that have been previously created in decision-making.
“We develop our own perceptions of what our patients and their families may want or need and form images related to their understanding of medical information and whether a particular family can participate in a shared-decision model. These shortcuts in imagery may act as facilitators or could have the opposite effect for minority populations, resulting in disparities of care.
“What is the true basis for the observed ‘reverse’ guideline-adherent disparity reported by Fleming-Dutra et al.? We hope it is due at least in part to conscious application of guideline recommendations among the practitioners caring for black children. We suspect it is partially due to perceptions of parent expectations or other influences on overprescribing of broad-spectrum antimicrobial agents for nonblack children.
“Regardless, these data provide an opportunity for all of us to reflect upon the beliefs and practices regarding race/ethnicity that may consciously or unconsciously influence clinical decision-making within ourselves and the institutional cultures in which we practice.”
Charles R. Woods, M.D., and V. Faye Jones, M.D., are in the department of pediatrics at the University of Louisville (Ky.). These comments are taken from an accompanying editorial (Pediatrics 2014 [doi:10.1542/peds.2014-3056]). The authors reported no disclosures or external funding.
“At face value, these data could indicate a ‘reversal’ in direction of the health care disparity usually identified in the United States. Fleming-Dutra et al. found no differences in care-seeking by black children versus nonblack children for upper respiratory tract conditions, suggesting that the difference in prescribing for acute otitis media was not due to differences in care-seeking behaviors among the families of black and nonblack children.
“We as physicians may enter the patient-provider relationship with our own set of biases, stereotypes, and expectations. We may subconsciously use the strategy of socialization to put people into categories (i.e., race) to use cognitive shortcuts that have been previously created in decision-making.
“We develop our own perceptions of what our patients and their families may want or need and form images related to their understanding of medical information and whether a particular family can participate in a shared-decision model. These shortcuts in imagery may act as facilitators or could have the opposite effect for minority populations, resulting in disparities of care.
“What is the true basis for the observed ‘reverse’ guideline-adherent disparity reported by Fleming-Dutra et al.? We hope it is due at least in part to conscious application of guideline recommendations among the practitioners caring for black children. We suspect it is partially due to perceptions of parent expectations or other influences on overprescribing of broad-spectrum antimicrobial agents for nonblack children.
“Regardless, these data provide an opportunity for all of us to reflect upon the beliefs and practices regarding race/ethnicity that may consciously or unconsciously influence clinical decision-making within ourselves and the institutional cultures in which we practice.”
Charles R. Woods, M.D., and V. Faye Jones, M.D., are in the department of pediatrics at the University of Louisville (Ky.). These comments are taken from an accompanying editorial (Pediatrics 2014 [doi:10.1542/peds.2014-3056]). The authors reported no disclosures or external funding.
“At face value, these data could indicate a ‘reversal’ in direction of the health care disparity usually identified in the United States. Fleming-Dutra et al. found no differences in care-seeking by black children versus nonblack children for upper respiratory tract conditions, suggesting that the difference in prescribing for acute otitis media was not due to differences in care-seeking behaviors among the families of black and nonblack children.
“We as physicians may enter the patient-provider relationship with our own set of biases, stereotypes, and expectations. We may subconsciously use the strategy of socialization to put people into categories (i.e., race) to use cognitive shortcuts that have been previously created in decision-making.
“We develop our own perceptions of what our patients and their families may want or need and form images related to their understanding of medical information and whether a particular family can participate in a shared-decision model. These shortcuts in imagery may act as facilitators or could have the opposite effect for minority populations, resulting in disparities of care.
“What is the true basis for the observed ‘reverse’ guideline-adherent disparity reported by Fleming-Dutra et al.? We hope it is due at least in part to conscious application of guideline recommendations among the practitioners caring for black children. We suspect it is partially due to perceptions of parent expectations or other influences on overprescribing of broad-spectrum antimicrobial agents for nonblack children.
“Regardless, these data provide an opportunity for all of us to reflect upon the beliefs and practices regarding race/ethnicity that may consciously or unconsciously influence clinical decision-making within ourselves and the institutional cultures in which we practice.”
Charles R. Woods, M.D., and V. Faye Jones, M.D., are in the department of pediatrics at the University of Louisville (Ky.). These comments are taken from an accompanying editorial (Pediatrics 2014 [doi:10.1542/peds.2014-3056]). The authors reported no disclosures or external funding.
Black children were less likely to be diagnosed with otitis media and more likely to be prescribed narrow-spectrum, rather than broad-spectrum, antibiotics compared with nonblack children, according to a recent study.
“These findings raise concerns that differences in care for otitis media based on race may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children,” wrote Dr. Katherine E. Fleming-Dutra of Emory University, Atlanta (Pediatrics 2014 [doi:10.1542/peds.2014-1781]).
After a study in the Philadelphia area showed lower otitis media diagnosis rates and less use of
broad-spectrum antibiotics for blacks compared with nonblacks, these researchers investigated race, diagnosis, and prescribing patterns nationwide.
They analyzed visits for children 14 years old and younger between 2008 and 2010 using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both data sets from the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Based on 4,178 visits in the database, the researchers estimated that 19.2 million visits for otitis media occurred from 2008 to 2010 in the United States. However, only 7% of black children’s visits included an otitis media diagnosis, compared with 10% of nonblack children’s visits (P = .004).
While black and nonblack children with otitis media were prescribed antibiotics at similar rates (81% vs. 76%, respectively, P = .30), black children were prescribed broad-spectrum antibiotics 42% of the time, compared with 52% for nonblack children (P = .01). Broad-spectrum cephalosporins were prescribed for otitis media for 12% of black children and 21% of nonblack children; broad-spectrum penicillins were prescribed for 10% of black children and 16% of nonblack children with otitis media.
After adjustment for age, gender, region, insurance, care setting, metropolitan area, and year, black children had 41% lower odds than did nonblack children of receiving a broad-spectrum antibiotic prescription for otitis media.
The study was funded by the CDC. Dr. Gerber and Dr. Hersh received a Pfizer research grant to implement antibiotic stewardship in children’s hospitals. The remaining authors had no relevant financial disclosures.
Black children were less likely to be diagnosed with otitis media and more likely to be prescribed narrow-spectrum, rather than broad-spectrum, antibiotics compared with nonblack children, according to a recent study.
“These findings raise concerns that differences in care for otitis media based on race may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children,” wrote Dr. Katherine E. Fleming-Dutra of Emory University, Atlanta (Pediatrics 2014 [doi:10.1542/peds.2014-1781]).
After a study in the Philadelphia area showed lower otitis media diagnosis rates and less use of
broad-spectrum antibiotics for blacks compared with nonblacks, these researchers investigated race, diagnosis, and prescribing patterns nationwide.
They analyzed visits for children 14 years old and younger between 2008 and 2010 using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both data sets from the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Based on 4,178 visits in the database, the researchers estimated that 19.2 million visits for otitis media occurred from 2008 to 2010 in the United States. However, only 7% of black children’s visits included an otitis media diagnosis, compared with 10% of nonblack children’s visits (P = .004).
While black and nonblack children with otitis media were prescribed antibiotics at similar rates (81% vs. 76%, respectively, P = .30), black children were prescribed broad-spectrum antibiotics 42% of the time, compared with 52% for nonblack children (P = .01). Broad-spectrum cephalosporins were prescribed for otitis media for 12% of black children and 21% of nonblack children; broad-spectrum penicillins were prescribed for 10% of black children and 16% of nonblack children with otitis media.
After adjustment for age, gender, region, insurance, care setting, metropolitan area, and year, black children had 41% lower odds than did nonblack children of receiving a broad-spectrum antibiotic prescription for otitis media.
The study was funded by the CDC. Dr. Gerber and Dr. Hersh received a Pfizer research grant to implement antibiotic stewardship in children’s hospitals. The remaining authors had no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Black children are less likely than nonblack children to receive otitis media diagnosis and broad-spectrum antibiotics.
Major finding: Black children are 30% less likely to be diagnosed with otitis media (P = .004) and 41% less likely to be prescribed broad-spectrum antibiotics.
Data source: Analysis of 4,178 visits for children aged 14 years and younger between 2008 and 2010 in two Centers for Disease Control and Prevention database sets.
Disclosures: The study was funded by the CDC. Dr. Gerber and Dr. Hersh received a Pfizer research grant to implement antibiotic stewardship in children’s hospitals. The remaining authors had no relevant financial disclosures.
