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J Pediatr ; 268: 113930, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38309525

RESUMO

OBJECTIVE: To evaluate whether racial and socioeconomic inequities in pediatric palliative care utilization extend to children with high-intensity neurologic impairment (HI-NI), which is a chronic neurological diagnosis resulting in substantial functional morbidity and mortality. STUDY DESIGN: We conducted a retrospective study of patients with HI-NI who received primary care services at a tertiary care center from 2014 through 2019. HI-NI diagnoses that warranted a palliative care referral were identified by consensus of a multidisciplinary team. The outcome was referral to palliative care. The primary exposure was race, categorized as Black or non-Black to represent the impact of anti-Black racism. Additional exposures included ethnicity (Hispanic/non-Hispanic) and insurance status (Medicaid/non-Medicaid). Descriptive statistics, bivariate analyses, and multivariable logistic regression models were performed to assess associations between exposures and palliative care referral. RESULTS: A total of 801 patients with HI-NI were included; 7.5% received a palliative referral. There were no differences in gestational age, sex, or ethnicity between patients who received a referral and those who did not. In multivariable analysis, adjusting for ethnicity, sex, gestational age, and presence of complex chronic conditions, Black children (aOR 0.47, 95% CI 0.26, 0.84) and children with Medicaid insurance (aOR 0.40, 95% CI 0.23, 0.70) each had significantly lower odds of palliative referral compared with their non-Black and non-Medicaid-insured peers, respectively. CONCLUSIONS: We identified inequities in pediatric palliative care referral among children with HI-NI by race and insurance status. Future work is needed to develop interventions, with families, aimed at promoting more equitable, antiracist systems of palliative care.


Assuntos
Disparidades em Assistência à Saúde , Doenças do Sistema Nervoso , Cuidados Paliativos , Encaminhamento e Consulta , Humanos , Cuidados Paliativos/estatística & dados numéricos , Masculino , Feminino , Estudos Retrospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pré-Escolar , Doenças do Sistema Nervoso/terapia , Doenças do Sistema Nervoso/etnologia , Lactente , Estados Unidos , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Socioeconômicos , Medicaid/estatística & dados numéricos , Racismo
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