Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities

Shah, Sanket U.; Melvin, Patrice; Tennermann, Nikki; Ward, Valerie L.

doi:10.1007/s00247-022-05460-1

Cited by 7 publications

(10 citation statements)

References 22 publications

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“…Future analysis could explore access barriers such as issues with transportation, finding child care for patient siblings, and parents who are unable to take time off from work. [14][15][16] Finally, the presence of unclear IDA etiologies, such as those with complex or multiple diagnoses, made it difficult to determine the factors that contributed most to the IDA, such as a patient who has menorrhagia in the setting of inadequate dietary intake with an underlying diagnosis of von Willebrand disease. This made it difficult to subcategorize patients to determine whether IV iron supplementation is best for a certain IDA etiology compared to others.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety

Strachan,

Kugler,

Devgan

et al. 2024

Journal of Investigative Medicine

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Pediatric iron deficiency anemia (IDA) is often treated with oral iron supplementation as the first-line therapy despite poor adherence. This single-institution retrospective chart review was conducted to assess the safety, efficacy, and adherence of intravenous (IV) iron infusions compared to oral iron in pediatric patients who had failed a trial of oral iron supplementation. We reviewed medical records of patients aged 1-21 with IDA who received at least one IV iron infusion at Cooper University Hospital between 2016 and 2021. Paired t-tests compared pre-infusion and post-infusion hematologic indices of hemoglobin (Hgb), mean corpuscular volume (MCV), red blood cell count (RBC), red cell distribution width (RDW), ferritin, total iron binding capacity (TIBC), iron stores, and iron saturation (% sat). We compared adherence and adverse reactions to both oral iron supplementation and IV iron infusions using a McNemar test. A total of 107 subjects were included (mean age of 12.7 years). Hemoglobin, ferritin, iron, and iron saturation between pre-infusion and post-final infusion significantly improved (p <0.001). Hemoglobin, ferritin and iron improved when subcategorizing by race and etiology of IDA. Adherence to IV iron infusions (70.1%) was significantly greater than adherence to oral iron therapy (43.0%). There were also significantly fewer adverse effects with IV iron infusions (3.7%) compared to oral iron (77.9%). We demonstrated the safety, efficacy, and improved adherence of IV iron infusions compared to oral iron supplementation for treatment of pediatric IDA in patients who were unable to tolerate oral iron supplementation.

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Section: Discussionmentioning

confidence: 99%

“…Future analysis could explore access barriers such as issues with transportation, finding child care for patient siblings, and parents who are unable to take time off from work. 14–16…”

Section: Discussionmentioning

confidence: 99%

Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety

Strachan,

Kugler,

Devgan

et al. 2024

Journal of Investigative Medicine

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“…It is important to note that we examined only race and ethnicity as opposed to other sociodemographic features, as race and ethnicity are most consistently available in clinical trial reports and subject to specific NIH reporting requirements. As a social construct, race categorizes individuals based on physical characteristics, and it is different from and should not be considered a proxy for geographic, biologic, or genetic ancestry . Thus, using these categories alone is insufficient to explain differences in clinical trial outcomes.…”

Section: Discussionmentioning

confidence: 99%

Reporting and Representation of Participant Race and Ethnicity in National Institutes of Health–Funded Pediatric Clinical Trials

Lee,

Narang,

Rees

et al. 2023

JAMA Netw Open

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ImportanceEnrolling racially and ethnically diverse pediatric research participants is critical to ensuring equitable access to health advances and generalizability of research findings.ObjectivesTo examine the reporting of race and ethnicity for National Institutes of Health (NIH)–funded pediatric clinical trials and to assess the representation of pediatric participants from different racial and ethnic groups compared with distributions in the US population.Design, Setting, and ParticipantsThis cross-sectional study included NIH-funded pediatric (ages 0-17 years) trials with grant funding completed between January 1, 2017, and December 31, 2019, and trial results reported as of June 30, 2022.ExposuresNational Institutes of Health policies and guidance statements on the reporting of race and ethnicity of participants in NIH-funded clinical trials.Main Outcomes and MeasuresThe main outcome was reporting of participant race and ethnicity for NIH-funded pediatric clinical trials in publications and ClinicalTrials.gov.ResultsThere were 363 NIH-funded pediatric trials included in the analysis. Reporting of race and ethnicity data was similar in publications and ClinicalTrials.gov, with 90.3% (167 of 185) of publications and 93.9% (77 of 82) of ClinicalTrial.gov reports providing data on race and/or ethnicity. Among the 160 publications reporting race, there were 43 different race classifications, with only 3 publications (1.9%) using the NIH-required categories. By contrast, in ClinicalTrials.gov, 61 reports (79.2%) provided participant race and ethnicity using the NIH-specified categories (P &lt; .001). There was racially and ethnically diverse enrollment of pediatric participants, with overrepresentation of racial and ethnic minority groups compared with the US population.Conclusions and RelevanceThis cross-sectional study of NIH-funded pediatric clinical trials found high rates of reporting of participant race and ethnicity, with diverse representation of trial participants. These findings suggest that the NIH is meeting its directive of ensuring diverse participant enrollment in the research it supports.

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“…These variables were included not for the purposes of assigning responsibility of missed specialty care to a specific group, but to represent the intersection of structural and social determinants, including socioeconomic, environmental, and societal factors, such as racism, along with individual experiences. [37][38][39] These results should not be used to justify limiting subspecialty referrals for certain populations, but rather highlight the multifactorial nature of these disparities as we seek to reduce them.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic

Rea

Toomey

Hauptman

et al. 2023

Clin Pediatr (Phila)

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Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children’s Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.

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Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities

Cited by 7 publications

References 22 publications

Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety

Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety

Reporting and Representation of Participant Race and Ethnicity in National Institutes of Health–Funded Pediatric Clinical Trials

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic

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