Disparities in Clinical Ethics Consultation among Hospitalized Children: A Case-Control Study

Abstract

To identify sociodemographic factors associated with pediatric clinical ethics consultation (CEC). Matched, case-control study at a single center, tertiary pediatric hospital in the Pacific Northwest. Cases (patients hospitalized January 2008-December 2019 with CEC) were compared with controls (those without CEC). We determined the association of the outcome (CEC receipt) with exposures (race/ethnicity, insurance status, and language for care) using univariate and multivariable conditional logistic regression. Of 209 cases and 836 matched controls, most cases identified as white (42%), had public/no insurance (66%), and were English-speaking (81%); most controls identified as white (53%), had private insurance (54%), and were English-speaking (90%). In univariate analysis, patients identifying as Black (OR: 2.79, 95% CI: 1.57, 4.95; P<.001), Hispanic (OR: 1.92, 95% CI: 1.24, 2.97; P=.003), with public/no insurance (OR: 2.21, 95% CI: 1.58, 3.10; P<.001), and using Spanish language for care (OR: 2.52, 95% CI: 1.47, 4.32; P<.001) had significantly increased odds of CEC, compared with patients identifying as white, using private insurance, and using English for care, respectively. In multivariable regression, Black race (adjusted OR: 2.12, 95% CI: 1.16, 3.87; P=.014) and public/no insurance (adjusted OR: 1.81, 95% CI: 1.22, 2.68; P=.003) remained significantly associated with receipt of CEC. We found disparities in receipt of CEC by race and insurance status. Further study is needed to determine the causes of these disparities.