Fewer black children receive antibiotics

Black children are less likely to receive a prescription antibiotic than their nonblack counterparts — even when treated by the same health provider — according to a study published today in Pediatrics.

The findings are based on 1.3 million doctor visits with the same 222 providers, and were independent of age, gender or type of insurance.

This is not the first time research has shown racial biases among health professionals. A smaller study at the University of Washington, showed that unconscious racial biases affected the amount of pain medication given to black children when they needed it. And a Johns Hopkins study highlighted that primary physicians with unconscious racial biases tended to dominate conversations with black patients, ignore their social needs and exclude them from the decision-making process.

However, today’s study is one of the few to look at its effects on respiratory infections and antibiotic use in children.

“Our goal has always been to find ways to improve antibiotic prescribing for children,” says study author Dr. Jeffrey S. Gerber, who is also assistant professor of pediatrics at the University of Pennsylvania School of Medicine’s Division of Infectious Diseases.

“These analyses [then] revealed the differences in prescribing by race.”

Although, what this study has uncovered may not be a negative. In the age of antibiotic overprescribing and the fear that unnecessary antibiotics later lead to “superbugs” that are too strong to treat, this may in fact be a good thing.

“Overprescribing of antibiotics to children with [respiratory tract infections] is common,” Gerber says.

He and his team suspect that the racial discrepancy may mean that non-black children are being prescribed too many antibiotics — not that black children are being deprived of necessary antibiotics. However, more research is needed to prove their theory.

The question still remains: why are black children receiving different treatments?

“The doctor-patient relationship is complex,” Gerber says. “Differences in parental expectations (‘My child needs antibiotics’), physician perception of parental expectations (‘This parent is going to demand antibiotics’), or the use of shared decision-making (‘Here are the options. Lets decide together how to proceed’) that correlate with patient race could account for some or most of the differential prescribing rates.”

The study did not identify the races of the treating health providers.

John Hoberman, professor of Germanic Studies at The University of Texas at Austin, examines racial biases among physicians in his book, Black & Blue: The Origins and Consequences of Medical Racism. Last year, in a release, he explains that until medical school curricula acknowledge historical medical racism and include new perspectives, enlightenment about these issues won’t occur.

The problem in Gerber’s study could also exist because the providers were missing the diagnosis altogether. Compared with nonblack children, the healthcare providers in Gerber’s study were also significantly less likely to diagnose an acute respiratory tract infection in their black pediatric patients.

So, in order to at least level the field on the prescribing issue, Gerber’s hope is that, in creating specific guidelines for physicians to follow when prescribing antibiotics, it will leave less to interpretation and that the discrepancies will ultimately improve.

“We are currently analyzing a study designed to do this,” he says.

Dr. Tyeese Gaines is a physician-journalist with over 10 years of print and broadcast experience, now serving as health editor for theGrio.com. Dr. Ty is also a practicing emergency medicine physician in New Jersey. Follow her on twitter at @doctorty or on Facebook.