Emergency Department Pediatric Readiness and the Search for Solutions That Promote Child Health Equity

Abstract

In JAMA Network Open, Jenkins et al 1 report alarming racial disparities in in-hospital mortality among children presenting to the emergency department (ED) for acute medical illnesses. In a sample of 633 536 children treated at 1 of 586 EDs across 11 states between 2012 and 2017, Black children with acute medical illness had higher adjusted odds of death compared with the overall sample mean.These findings add to an upsetting body of literature demonstrating that, throughout health care, Black children have disproportionately high rates of death. Black children are more likely than children of other races to die of sepsis, sudden cardiac arrest, congenital heart disease, and cancer, as well as after routine outpatient surgery. 2 Although long-standing structural racism has led to Black children having elevated disease burden and risk of health-related social need, this does not sufficiently explain the inequitably high mortality rate. Jenkins et al 1 present findings similar to others: racial inequities in child mortality persist when accounting for sociodemographic factors, disease complexity, and illness acuity. With the critical recognition that race and ethnicity are social