April 30, 2012 -- Black children seen in the emergency department for abdominal pain are less likely to receive pain medication than white children, according to a new study.
The research, which also found that black and Hispanic children were more likely to experience an ER stay longer than six hours compared to white children -- even when the same tests were ordered -- raises questions on how race may affect hospital care when it comes to the youngest patients.
The study was presented Saturday at the Pediatric Academic Societies (PAS) annual meeting in Boston.
Lead study author Dr. Tiffani J. Johnson, pediatric emergency medicine fellow at the Children's Hospital of Pittsburgh, says she has a strong interest in improving the quality and equity of care that kids receive in the ER.
"If we don't recognize disparities, we're never going to be able to close the gaps," says Johnson.
Johnson and colleagues used data from the CDC's National Hospital Ambulatory Medical Care Survey, which included more than 2,000 children from 550 hospitals who visited the ER for abdominal pain between 2006 and 2009.
Black children were 39 percent less likely to receive pain medications compared to white children with similar medical situations. When their pain was severe, rated 7 or higher on a pain scale from 0 to 10, an even larger disparity was observed.
Dr. Marilyn Hughes Gaston, a pediatrician and co-director of The Gaston and Porter Health Improvement Center in Potomac, Md., has dedicated much of her professional career to improving the health of poor and minority families.
She said the study's findings are an essential step towards achieving equality in health care and the focus on kids is especially important.
"Every study like this one gives us more and more information," says Gaston. "We have to dispel stereotypes and assumptions that interfere with care."
Children are always at greater risk to be undertreated or mistreated compared to adults because of their limited ability to communicate how they feel. Anything else that negatively impacts their care would be important to identify so that providers can be educated.
So what factors are to blame for this problem? Little is known about pain expression and perception in children, but the issue has been studied extensively in adults.
Past research has shown that race can affect the way that adults express their pain. A 2002 study published in the International Journal of Intercultural Relations found that black patients were less likely to disclose the fact that they were in pain than their white counterparts. When they did discuss their pain they were less likely to describe its intensity.
And doctors might also be less skilled in recognizing the pain of certain races. Specifically, doctors were almost twice as likely to underestimate the pain of black patients compared to other ethnicities in a 2007 study from the University of Tennessee College of Medicine.
Whether either of these findings applies to pain in children is simply not known. Johnson says we need additional studies to find out exactly what factors lead to variations in care.
"Now we need to look at where these differences are coming from," says Johnson. "Are they at the patient level, the parent level or the physician level?"
In the meantime, Johnson says, her study's findings offer an important reminder to doctors.
"I hope that providers caring for children will recognize this," she says, "and make efforts to ensure they are proving appropriate pain control for children of all ethnicities."