Hospitals admit white kids with lesser emergencies

Studies have shown that white children are hospitalized more often for medical emergencies than Hispanic or black children. Researchers from George Washington University School of Medicine assumed that the disparity was because the children of color were receiving less aggressive care. But in a new study, researchers found instead that all children were admitted equally when they had true emergencies, and the white children were over-admitted for conditions that could be readily treated at home. Using data available on 8,952 children at 13 pediatric emergency rooms across the country researchers compared observed and expected admission rates for different levels of illness severity, and found that blacks , Hispanics, and whites were equally likely to be admitted if they were severely ill. However, in case of less severe illnesses such as gastroenteritis or pneumonia, which can be easily treated at home, they found that white children were 1.6 times more likely to be admitted than black or Hispanic children. Although the study was not designed to figure out why these disparities exist, lead author Dr. James Chamberlain, also of Children's National Medical Center, speculates that there may be subtle pressures from both families and hospital administrators to admit certain patients, even if it is not medically necessary.

BOTTOM LINE: While it is reassuring to know there is no discrimination between races in pediatric emergency care, over-admitting white children who are not severely ill is adding to healthcare costs and is also exposing these children to germs and other risks in hospitals, said Dr. Chamberlain.

CAUTIONS: Because of privacy issues, the researchers could not get information on the socioeconomic status of the study's participants. These data might have contributed to a better understanding of why white children are over-admitted.

WHAT'S NEXT: This is part of a larger National Institutes of Health-funded study to better understand and address disparities in healthcare. The researchers want to now see if obesity, asthma, sudden infant death syndrome, and bone health are related to socioeconomic status.

WHERE TO FIND IT: Pediatrics, June 4

SENA DESAI GOPAL

DEPRESSION Early sibling relationships

may predict emotional health

The quality of relationships people have with their siblings during childhood may predict depression later on in life, researchers at Brigham and Women's Hospital have found. The findings, which come from a study that has lasted 68 years, show that men who had poor relationships with their siblings prior to the age of 20 were more likely than men with good sibling relationships to have suffered from major depression and to use mood-altering drugs by the time they were 50. The study followed 229 men who were evaluated periodically beginning in their late teens on variables including family history of depression and quality of parental care, as well as quality of sibling relationships and occurrence of major depression by the age of 50. Quality of parental care during childhood did not correlate with later depression, while sibling relationships did.

BOTTOM LINE: "The way that kids learn to deal with peers begins with siblings," said Dr. Robert Waldinger, the study's lead author. "In adult life, relating to peers is essential for one's social life and occupation. If you don't develop these crucial skills early on, you might have difficulty with people later, which might make you vulnerable to depression."

CAUTIONS: It is unknown whether poor sibling relationships during childhood contribute to adult depression or are an early sign of vulnerability to depression. Also, the study did not include women, who, Waldinger acknowledged, might have shown different outcomes, or people without siblings.

WHAT'S NEXT: Waldinger and his colleagues are looking to the data for early predictors of marriage quality and how people age cognitively.

WHERE TO FIND IT: American Journal of Psychiatry, June.

AMI ALBERNAZ