Do Healthcare Disparities Play a Role in Pediatric Testicular Torsion?- Analysis of a Single Large Pediatric Center
Albert S T Lee, DO, PharmD, Hans Pohl, MD, H G. Rushton, MD, Md Sohel Rana, MBBS, MPH, Tanya Davis, MD.
Children's National Hospital, Washington, DC, USA.
BACKGROUND: Healthcare disparities have been shown to impact outcomes of various acute pediatric conditions. We sought to examine the impact of race, ethnicity, and insurance status on the presentation, management, and outcome of testicular torsion.
METHODS: A retrospective review of a prospectively maintained testicular torsion database was performed. Patients ≤ 18 years of age evaluated in our pediatric institutionís emergency room between April 2016- April 2020 with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR, and orchiectomy rate were extracted and compared. P < 0.05 was considered statistically significant.
RESULTS: A total 206 patients were included. 114 (56.2%) were Black or African American (Black/AA), 43 were (21.2%) Hispanic/Latino, 22 (10.8%) were Caucasian, and 24 (11.8%) were designated as Other races. Ninety-eight (48.3%) patients had Medicaid, 90 (44.3%) had private insurance, and 15 (7.4%) patients were uninsured. Sixty-eight (33.0%) presented in a delayed fashion (>24 hrs). Compared to the Caucasian patients, Black/AA patients were 2.1 years (95% CI: 0.5, 3.8; P= 0.010) older at the time of presentation. When compared to those with Medicaid insurance, uninsured patients had 6.26 times (95% CI: 1.58, 41.88; P=0.021) higher odds to be referred from an outside hospital for management. In those patients presenting acutely (<24 hrs, N=138), there were no significant differences in the odds of orchiectomy for Black/AA or Hispanic/Latino patients when compared to Caucasian patients, however, the odds of orchiectomy in Other races (non-Caucasian, non-Black/AA, non-Hispanic/Latino) was significantly higher (OR: 10.38; 95% CI: 1.13, 246.96; P= 0.049). While the mean time in minutes from ED to OR was longer in those with Medicaid insurance (141 vs 125.4 private vs 115 uninsured, p= 0.042), this did not impact the orchiectomy rate (39.8% vs 40.9% vs 46.7%, p=0.88).
CONCLUSIONS: We found no differences in the orchiectomy rates by race with the exception of a higher rate in the diverse and heterogeneous Other race (non-Caucasian, non-Black/AA, non-Hispanic/Latino) group. Those uninsured had a higher referral rate highlighting the potential existence of disparities for those uninsured and the need for further investigation.
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