Examination of Racial, Socioeconomic Impact on EMS Transfers Among Children With Asthma

Asthma is a prevalent medical condition among children, frequently encountered by Emergency Medical Services (EMS). While disparities in health care for children with asthma are known in various settings, there has been limited research into disparities in prehospital care.

A recent study aimed to address this gap by examining prehospital treatment and transport of children with asthma exacerbations in relation to race and ethnicity, within the context of community socioeconomic status.

The study was a retrospective analysis of EMS encounters that occurred in 2019, involving children aged 2 to 17 years who presented with asthma and wheezing. The researchers used a national prehospital database to collect and analyze data. The primary outcomes under investigation included EMS transport and the administration of prehospital bronchodilators or systemic corticosteroids. To assess the socioeconomic context, the researchers used the social vulnerability index. The study employed statistical methods, including generalized estimating equations, to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for prehospital bronchodilator and steroid use based on race and ethnicity. These estimates were adjusted for variables such as age, abnormal vital signs, community size, pre-EMS bronchodilator use, and transport disposition.

The analysis involved a total of 5266 EMS encounters, with a median age of 8 years for the children involved. Among the study population, 53% were Black non-Hispanic, and 34% were White non-Hispanic. The majority, 77%, were transported by EMS.

The study findings revealed several significant disparities:

• Transport Disparities: Black non-Hispanic children were 25% less likely to be transported by EMS compared to White non-Hispanic children, as indicated by an adjusted odds ratio of 0.75.
• Bronchodilator Administration: EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White non-Hispanic patients. In adjusted analyses that considered community socioeconomic status and potential confounding variables, Black non-Hispanic children were 55% more likely to receive bronchodilators from EMS compared to White non-Hispanic children.
• Corticosteroid Administration: The study found that systemic corticosteroids were administered in only 3% of all encounters, with no significant difference in the odds of prehospital systemic corticosteroid administration based on race and ethnicity.

Overall, the study highlighted disparities in prehospital care for children with asthma exacerbations. Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma, and they were more likely to receive bronchodilators when adjusted for community socioeconomic status. However, these children were less likely to be transported by EMS.

The findings of this study emphasize the need for further investigation and interventions to address these disparities and ensure equitable care for all children with asthma, regardless of their racial or ethnic background.

Reference:

Owusu-Ansah S, Crowe RP, Ramgopal S. Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma [published online ahead of print, 2023 Sep 25]. Prehosp Emerg Care. 2023;1-8. doi:10.1080/10903127.2023.2260471