Respiratory Infectious Disease Hospitalizations in American Indian Children Presenting to the Emergency Department in the Upper Midwest

INTRODUCTION:  American Indian (AI) children are hospitalized at almost twice the rate of the general population for lower respiratory infections. This variation in care may be secondary to severity of illness, access to primary care or disparity in care provided in the emergency department (ED). We examined differences in hospital admissions in AI children compared to White children presenting to the ED with a respiratory infection in a large multi-center cohort to elucidate possible disparities.

METHODS:  We collected data on all children 0-17 years presenting to one of six geographically diverse EDs in the upper Midwest from June 2011 to May 2012. Our analyses were limited to patients who self –identified as White or AI and were diagnosed with any respiratory infection (based on the Diagnostic Grouping System for Child ED Visits). We explored differences in admission by race after adjusting for age, insurance type, triage level, and rural/urban setting using multiple logistic regression.  We also explored possible interactions with race, triage level, and insurance status.

RESULTS:  A total of 4,329 encounters in the ED resulted in a primary diagnosis of a respiratory infection with 1,301 (30%) resulting in hospitalization.  Children that were either < 1 year of age, at a high triage level, or from an urban setting were more likely to be admitted. After controlling for confounders, AI children presenting to the ED were less likely to be admitted for a respiratory infection than White children [OR=0.40, 95% CI (0.28, 0.58)]. Similar results were obtained when limiting to only lower respiratory-tract infections [OR=0.36, 95% CI (0.23, 0.57)].

CONCLUSIONS:  We found a lower odds of admission for AI children presenting to the ED with a respiratory infection compared to White children after adjusting for confounders.  Future efforts will work to address and improve this potential disparity.