Increased Healthcare Resource Utilization despite Lower Disease Severity among Latino Children with Acute Respiratory Illness

RATIONALE: Compared with other groups, Latino children have increased difficulty accessing outpatient healthcare, but receive more aggressive acute care, including for asthma, possibly to compensate for language barriers. Whether this is true of acute care for bronchiolitis has not been studied.METHODS: We studied 674 children enrolled in the Tennessee Children's Respiratory Initiative, who were <1 year old with symptoms consistent with acute respiratory illness. Child/family demographics and child clinical presentation, disease severity, and resource utilization were determined.RESULTS: The cohort was 14% Latino, 52% white, 22% African-American, and 12% other races/ethnicities. Mothers of Latino children were 36% Spanish-speaking. Latino children had lower rates of daycare attendance, secondhand smoke exposure, and family history of atopy. Bronchiolitis severity was increased in whites (5.8±3.4 points on a 0-12 point scale) versus Latinos (3.8±3.1) and African-Americans (3.8±3.2), p<0.001. 64% of whites and about half of other children were admitted (p=0.48). 79% of white children had a principal discharge diagnosis of bronchiolitis, versus 58% of Latinos and 56% of African-Americans (p<0.001); symptom prevalences were similar between Latino and African-American children. However, Latino children were the group most likely to receive antibiotics (57%) and parenteral steroids (18%) and to have cultures performed of blood (41%), urine (41%), and CSF (28%); p for all comparisons <0.001.CONCLUSIONS: Latino children with acute respiratory illness had greater utilization of diagnostic testing and antibiotics compared with other groups, despite lower disease severity, perhaps due to difficulty obtaining clinical history due to language barriers. Measures to facilitate effective communication may reduce this disparity. RATIONALE: Compared with other groups, Latino children have increased difficulty accessing outpatient healthcare, but receive more aggressive acute care, including for asthma, possibly to compensate for language barriers. Whether this is true of acute care for bronchiolitis has not been studied. METHODS: We studied 674 children enrolled in the Tennessee Children's Respiratory Initiative, who were <1 year old with symptoms consistent with acute respiratory illness. Child/family demographics and child clinical presentation, disease severity, and resource utilization were determined. RESULTS: The cohort was 14% Latino, 52% white, 22% African-American, and 12% other races/ethnicities. Mothers of Latino children were 36% Spanish-speaking. Latino children had lower rates of daycare attendance, secondhand smoke exposure, and family history of atopy. Bronchiolitis severity was increased in whites (5.8±3.4 points on a 0-12 point scale) versus Latinos (3.8±3.1) and African-Americans (3.8±3.2), p<0.001. 64% of whites and about half of other children were admitted (p=0.48). 79% of white children had a principal discharge diagnosis of bronchiolitis, versus 58% of Latinos and 56% of African-Americans (p<0.001); symptom prevalences were similar between Latino and African-American children. However, Latino children were the group most likely to receive antibiotics (57%) and parenteral steroids (18%) and to have cultures performed of blood (41%), urine (41%), and CSF (28%); p for all comparisons <0.001. CONCLUSIONS: Latino children with acute respiratory illness had greater utilization of diagnostic testing and antibiotics compared with other groups, despite lower disease severity, perhaps due to difficulty obtaining clinical history due to language barriers. Measures to facilitate effective communication may reduce this disparity.