The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Abstract

Objective In 2012, Black or African American children constituted 21% of pediatric tracheostomies while representing approximately 15% of the US population. It is unclear if this discrepancy is due to differences in associated diagnoses. This study aimed to analyze the incidence of pediatric tracheostomy in the United States from 2003 to 2016 and to determine the odds of placement among Black children when compared with other children. Study Design Retrospective. Setting Academic hospital. Subjects and Methods We used the 2003 to 2016 Kid Inpatient Database to determine the incidence of pediatric tracheostomy in the United States and determine the odds of tracheostomy placement in Black children when compared with other children. Results A total of 26,034 pediatric tracheostomies were performed between 2003 and 2016, among which, 21% were Black children. The median age was 7 years (interquartile range [IQR] = 0 to 17); 43% were ≤2 years old, and 62% were male. The most common principal diagnosis was respiratory failure (72%). When compared with other children, Black children were more likely to undergo tracheostomy (odds ratio [OR] = 1.2; 95% CI, 1.1-1.3), which increased among children younger than 2 years old (OR = 1.5; 95% CI, 1.4-1.5). Black children with tracheostomies were also more likely to be diagnosed with laryngeal stenosis and bronchopulmonary dysplasia and to have an extended length of stay ( P < .001). Conclusion Black children are 1.2 times more likely to undergo tracheostomy in the United States compared with other children. Further investigation is warranted to evaluate if there are underlying anatomical, environmental, or psychosocial factors that contribute to this discrepancy.

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

“…56 Black race has also been associated with prolonged length of stay after pediatric tracheostomy placement. 56,57 Similarly, our results identified a higher percentage of nonwhite children from more disadvantaged communities, suggesting that race may affect outcomes. Further, the more disadvantaged group, as expected, more commonly had Medicaid coverage, lower median income, and higher percent of community poverty.…”

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

“…Standardized cost was consistent with other studies examining national registries. 2,22,23 In general, costs are determined by the LOS and it should be anticipated that complex children requiring tracheostomy have more total cost. Efforts to reduce LOS and barriers to discharge should have the greatest potential to reduce overall cost.…”

“…33,34 According to the Kid Inpatient Database, black children are 1.2 times more likely than children of other races to undergo tracheostomy in the US, and this likelihood increases with younger age even after controlling for other factors. 22 The reasons behind this are unclear, and further investigation to determine this worrisome trend is warranted.…”

Parent perspectives on facilitating decision‐making around pediatric home ventilation

“…We also did not include parents whose primary language was not English. Evidence suggests that racial minority children are more likely than others to receive tracheostomy 35–37 and possibly home ventilation. Exclusion of these valuable perspectives limits the generalizability of our results.…”