Racial differences in antibiotic prescribing by primary care pediatricians.

TitleRacial differences in antibiotic prescribing by primary care pediatricians.
Publication TypeJournal Article
Year of Publication2013
AuthorsGerber JS, Prasad PA, A Localio R, Fiks AG, Grundmeier RW, Bell LM, Wasserman RC, Rubin DM, Keren R, Zaoutis TE
Date Published2013 Apr
KeywordsAcute Disease, Adolescent, African Americans, Anti-Bacterial Agents, Child, Child, Preschool, Cohort Studies, Electronic Health Records, European Continental Ancestry Group, Female, Healthcare Disparities, Humans, Infant, Infant, Newborn, Logistic Models, Male, Multivariate Analysis, Otitis Media, Pediatrics, Physician's Practice Patterns, Primary Health Care, Respiratory Tract Infections, Retrospective Studies

OBJECTIVE: To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician.

METHODS: Retrospective cohort study of 1,296,517 encounters by 208,015 children to 222 clinicians in 25 practices in 2009. Clinical, antibiotic prescribing, and demographic data were obtained from a shared electronic health record. We estimated within-clinician associations between patient race (black versus nonblack) and (1) antibiotic prescribing or (2) acute respiratory tract infection diagnosis after adjusting for potential patient-level confounders.

RESULTS: Black children were less likely to receive an antibiotic prescription from the same clinician per acute visit (23.5% vs 29.0%, odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.72-0.77) or per population (0.43 vs 0.67 prescriptions/child/year, incidence rate ratio 0.64; 95% CI 0.63-0.66), despite adjustment for age, gender, comorbid conditions, insurance, and stratification by practice. Black children were also less likely to receive diagnoses that justified antibiotic treatment, including acute otitis media (8.7% vs 10.7%, OR 0.79; 95% CI 0.75-0.82), acute sinusitis (3.6% vs 4.4%, OR 0.79; 95% CI 0.73-0.86), and group A streptococcal pharyngitis (2.3% vs 3.7%, OR 0.60; 95% CI 0.55-0.66). When an antibiotic was prescribed, black children were less likely to receive broad-spectrum antibiotics at any visit (34.0% vs 36.9%, OR 0.88; 95% CI 0.82-0.93) and for acute otitis media (31.7% vs 37.8%, OR 0.75; 95% CI 0.68-0.83).

CONCLUSIONS: When treated by the same clinician, black children received fewer antibiotic prescriptions, fewer acute respiratory tract infection diagnoses, and a lower proportion of broad-spectrum antibiotic prescriptions than nonblack children. Reasons for these differences warrant further study.

Alternate JournalPediatrics
PubMed ID23509168
Grant ListHHSA2900200710013. / / PHS HHS / United States