Study: Black Children Treated Differently in ER Than Whites

Research by a leading children's hospital finds a disparity in the prescribing of painkillers.

Photo by Shutterstock

By Chris Hoenig

Photo by Shutterstock

Black children are less likely to be prescribed painkillers when they go to the ER than white children, according to a new study.

Researchers at Children's Hospital of Philadelphia (CHoP) found that 27 percent of white children who arrived in severe stomach pain were prescribed some form of painkiller, but only 16 percent of Black and 19 percent of Latino kids received the same treatment. The study included painkillers from ibuprofen and acetaminophen, like Advil or Tylenol, to more powerful narcotic painkillers, such as oxycodone.

Severe pain was defined as a score of 7 or higher from the patient, on a 1–10 scale.

Overall, the research team found that even though the number of tests ordered and the number of children admitted to the hospital didn't vary by race or ethnicity, Black children were 39 percent less likely to receive any painkillers at all and had 62 percent less chance of being prescribed an opioid than whites. The study also found that Black and Latino children spent longer dealing with the pain in the hospital, including a 70 percent greater chance of spending six-plus hours in the ER than white kids.

Stereotypes to Blame?

Physicians' oaths—whether the modern version adopted by the World Medical Association ("I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation or social standing to intervene between my duty and my patient") or the more classic Hippocratic Oath used by many universities ("That into whatever house I shall enter, it shall be for the good of the sick")—provide for equal treatment of the sick.

Study author Dr. Tiffani Johnson put some of the blame for the disparities on the attitudes of ER doctors. Noting the stressful environment of the ER, Johnson said that doctors are "more likely to be influenced by stereotypes or bias" when working in a high-pressure setting. The research team said further research should look into additional factors, including the formula used for kids' painkillers and the availability of primary-care physicians.

While Black and Latino children are expected to enter the health-insurance marketplace in large numbers with the implementation of the Affordable Care Act, the number of Blacks enrolling in medical school is reaching a low not seen in decades. And though hospitals are working to create pipelines to help recruit the best Black and Latino candidates, it may take years before the growth of Black and Latino doctors matches the growth of Black and Latino children in the healthcare marketplace.

Not Only in Children

The results of the CHoP study are similar to those of a study of adult patients by University of Rochester Medical Center researchers earlier this year. That study also found that Black patients were less likely to receive painkillers and went on to identify income as a factor. At hospitals in wealthier areas, adults being treated in the ER received prescription painkillers 49 percent of the time, while low-income ER patients were treated with prescription painkillers only 39 percent of the time.

Dr. Robert Fortuna, author of the University of Rochester study, disagreed about the cause, however. "I don't believe the vast majority of physicians knowingly or consciously treat patients differently," he said. "The bottom line is that minority children in this study were less likely to receive pain medications, and that's concerning. Moving forward, we need to better understand why these disparities exist and work to correct them."


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