A number of people have written me (about my post on racial disparities in the treatment of pain in kids with appendicitis) with basically this question:
My question is this: could this be related to the type of hospital the kids went to, or was that controlled for? In other words, might there be disparities in how pain is treated by inner-city hospitals that get a higher proportion of African-American patients in the ED, versus suburban/rural hospitals that get more whites?
This is a valid question, if you are considering how to fix the problem.
The researchers were able to control for region (ie Northeast, Midwest, South, and West) and whether the patient was seen in a pediatric ED or general ED. But they couldn’t adjust for individual hospital. This means that differences could be in the way that we treat individual patients (ie blacks get treated differently than whites). It could also be that it’s a difference in doctors, and some doctors see more blacks than whites. Or it could be a differences in hospitals – ie those hospitals that treat a predominantly black population use pain medication differently than those that treat a predominantly white population.
But I’d argue that this information would only be meaningful for intervention purposes. Even if these are hospital differences, and the fact that black kids’ pain is being ignored is because they are seen at hospitals that mainly care for minority populations, it’s still horrific.
There are disparities. Whether we need to fix them at the patient level, the doc level, or the hospital level – we still need to fix them. Now.