Racial Inequity in Pediatric Anesthesia

Abstract

Purpose of Review Minority health disparities have received renewed attention in the USA following several highly publicized racial injustices in 2020. Though the focus has been largely on adults, children are not immune to these inequities. By reviewing racial disparities in pediatric perioperative care, we aim to engage the anesthesia community in the fight against systemic racism. Recent Findings Minority children have higher rates of anesthetic and surgical morbidity compared to White children, including respiratory events, length of stay, hospital costs, and even death. These inequities occur across surgical specialties and environments. Summary Racial disparities in the perioperative health and management of children are ubiquitous. Herein, we will summarize recent pediatric health disparity literature, discuss some important contributors to persistent inequities, and propose avenues for anesthesiologists to impact the pursuit of equitable healthcare outcomes.

The intersection of pediatric anesthesiology and social determinants of health

“…There is a growing body of literature documenting pediatric perioperative care disparities and treatment inequities [1,2 ▪ ], which underscores the need to identify and address factors driving disparities in pediatric perioperative care. To date, evidence of pediatric perioperative disparities has primarily come from research comparing perioperative outcomes across racial and ethnic groups, with data indicating that children of racial and ethnic minoritized groups are more likely to experience inequitable care and poorer outcomes, including more postoperative complications, longer lengths of stay, and inadequate perioperative pain management [1,2 ▪ ]. To identify treatment practices that promote more equitable care and outcomes, it is imperative to appreciate and identify multidimensional, systemic, and social mechanisms driving these disparities.…”

“…Of note, this review will present research that goes beyond examining racial disparities (i.e., differences in perioperative outcomes across racial or ethnic groups) and incorporates the measurement of SDOH variables and analyzes the effect of SDOH on perioperative outcomes. For an update on racial disparities in pediatric anesthesia, please see recent reviews by Willer et al [2 ▪ ] and Tan et al [1] for a comprehensive overview of racial disparities in pediatric anesthesia and perioperative pain management…”

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“…La dificultad inherente para la adquisición de competencias en situaciones críticas, puede solventarse con la adquisición de destrezas en ambientes simulados, pero dichos centros de simulación muestran inequidad en su distribución, comportándose como un nuevo factor de inequidad, específicamente inequidad en educación en salud (Figura 1), una nueva barrera a las ya existentes, que contribuyen a peores resultados quirúrgicos y mayor mortalidad, sobre todo en población pediátrica y minorías étnicas [7], [8].…”