White Kids Are More Likely to Be Given Antibiotics They Don't Need

There's no shortage of ways being a minority can affect your health—from dealing with more stress as a result of discrimination to being less able to even afford seeing a doctor when sick. But a new study published Tuesday in the journal Pediatrics suggests there might be at least one unintentional benefit of being treated differently by doctors because of your skin color or ethnicity: Your kids are less likely to get useless antibiotics in the emergency room.

The researchers examined the records of nearly 40,000 patients who visited one of seven pediatric emergency departments in 2013. They looked at how often kids were prescribed antibiotics for an acute respiratory infection caused by a virus—a common marker of antibiotic misuse, since the drugs can't kill viruses. They found that just 2.6 percent of kids who went to the ER for a respiratory infection (like the common cold) were treated with antibiotics, which is reassuring.

Delving deeper, though, they also found white kids were twice as likely to be prescribed antibiotics as non-white kids were. After controlling for insurance status, they found that while 4.3 percent of white children were given antibiotics, only 1.9 percent of black children and 2.6 percent of Hispanic children were. The Rx rate for other non-Hispanic kids was 2.9 percent. Research elsewhere has found a similar gap in antibiotic prescription rates when visiting a primary care doctor and racial differences exist for other types of ER treatment including CT scans for minor head trauma, radiology and lab tests, and pain management.

The overall low rate of unneeded antibiotic prescriptions is, on one hand, an encouraging sign, given how this kind of overuse has sped along the rise of antibiotic-resistant bacteria. But the findings are yet another reminder of how doctors subtly treat their patients differently for seemingly no other reason than their race or ethnicity.

"Unfortunately, today's results provide further evidence of racial and ethnic differences in providing health care in the ED setting," lead author Monika Goyal, director of research in the division of emergency medicine at the Children's National Health System in Ohio, said in a statement. "Although, in this case, minority children received evidence-based care, more study is needed to explain why differences in care exist at all," adding, "In addition to providing the best evidence-based care, we also strive to provide equitable care to all patients."

While the study can't answer why these differences exist, Goyal and her team do offer some theories. For instance, white parents could be more vocal in pressuring doctors to give their children something, regardless of whether it will work or not. They cited previous research showing that doctors may underestimate minority parents' expectations for antibiotics. Doctors might also want to more often go above and beyond for their white patients, even without knowing they're doing so, which is known as implicit bias.

"It may come down to factors as simple as providers or parents believing that 'more is better,' despite the clear public health risks of prescribing children antibiotics unnecessarily," Dr. Goyal said. "In this case, an intervention that educates parents and providers about appropriate antibiotic use could help the pediatric patients we care for today as well as in the future."

Goyal and her team next plan to study the factors that could influence these racial and ethnic differences; she has a grant from the National Institutes of Health to do so.

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