Differences in antibiotic treatment for children hospitalized with pneumonia.

Abstract

Prior work has identified disparities in antibiotic use for children in the ambulatory setting, but few studies have explored antibiotic disparities in the inpatient setting. We evaluated the association of both race and ethnicity and Childhood Opportunity Index (COI) with antibiotic utilization for children hospitalized with pneumonia. This cross-sectional study included children hospitalized with pneumonia at one of 43 hospitals in the Pediatric Health Information System (2022-2024). We evaluated the association between race and ethnicity and COI quintiles (very low quintile representing the lowest opportunity neighborhoods) and antibiotic utilization using generalized estimating equations adjusted for confounders. Antibiotic utilization included any antibiotics and among children with antibiotics, use of broad- versus narrow-spectrum and intravenous versus oral antibiotics. Among 49,332 children, compared with non-Hispanic White children, we found higher odds of receiving antibiotics among Asian (86% vs. 80%; odds ratio [OR]: 1.45 (95% confidence interval [CI]: 1.14, 1.84]) and non-Hispanic Black children (83% vs. 80%; OR: 1.59 [1.17, 2.15]). Hispanic children had greater odds receiving broad- rather than narrow-spectrum antibiotics (52% vs. 46%; OR: 1.30 [1.03, 1.63]). Compared with non-Hispanic White children, all other groups had greater odds of intravenous rather than oral antibiotics. Compared with children in the very high COI quintile, children in the very low COI quintile had greater odds of receiving antibiotics (86% vs. 79%; OR: 1.69 [1.12, 2.55]) and broad-spectrum antibiotics. Children of some minoritized backgrounds and those residing in the lowest opportunity neighborhoods had greater odds of receiving antibiotics, broad-spectrum antibiotics, and intravenous antibiotics for pneumonia.