286 - Experiences of Discrimination Among Caregivers of Hospitalized Children

Poster Number: 286
Publication Number: 286.1880

Background: Perceived healthcare discrimination negatively impacts health-related quality of life. Little data exists exploring caregiver experiences of discrimination during their child’s pediatric hospitalization.

Objective: We aimed to explore caregiver experiences of discrimination during their child’s hospitalization and identify opportunities for systemic improvement.

Design/Methods: This was a cross-sectional survey of a convenience sample of English- and Spanish-speaking caregivers of hospitalized children on the pediatric hospital medicine service at a quaternary children’s hospital from May to October 2023. Consenting caregivers completed a 110-item survey on a tablet while inpatient. Survey components included the Discrimination in Medical Settings (DMS) survey covering experiences 12 months prior to admission and again regarding the current inpatient stay, a modified Barriers to Care Questionnaire, and medical mistrust, adapted from Understanding Healthcare and Racism, and the Survey on Racism and Health. The primary outcome was the composite score of DMS over the last 12 months. Median DMS was reported with interquartile ranges (IQR). We compared the demographics and experiences of caregivers with a DMS score of < 75%ile (low or average discrimination) to those with a DMS score ≥75%ile (high discrimination). We used Fisher Exact and Kruskal Wallis testing to compare categorical and continuous variables, respectively.

Results: We enrolled 250 caregivers. Caregivers were 48% Hispanic, 18% Black, 33% White, and 37% were Spanish-speaking (Table 1). The median composite 12-month DMS score was 9 (IQR: 7-14). In univariate analysis, a higher 12-month DMS score was associated with Black race (p < 0.01) and higher education status (p=0.02). In multivariable logistic regression, Black race remained significantly associated with 12-month DMS ≥75% (OR 3.43, 95% CI 1.27-9.29). There was significantly greater medical mistrust of the healthcare system and medical providers among caregivers who experienced the highest levels of DMS (Table 2). Inpatient median DMS scores were 7 (IQR 7-7) and 8 (IQR 7-13) for caregivers with 12-month DMS scores < 75% and ≥75%, respectively (p < 0.01).

Conclusion(s): This study characterizes the experiences of discrimination among caregivers of hospitalized children. It highlights the persistence of discrimination irrespective of education or income level and the association between discrimination and higher rates of medical mistrust. Future research should explore the impact of these experiences of discrimination on outcomes in hospitalized pediatric patients to address systemic inequities.