Disparities in Urine Testing Among Febrile Children in US Emergency Departments

Objective To evaluate the association of race and ethnicity with urine testing for febrile children in the emergency department and to measure trends in urine testing from 2002 to 2021. Study Design/Methods We conducted a cross-sectional analysis of children aged 2-24 months with a recorded temperature of >= 38 degrees C who presented to an emergency department in the United States from 2002 to 2021 using the National Hospital Ambulatory Medical Care Survey. We assessed trends in urine testing stratified by sex, race, and ethnicity over two decades and performed univariate and multivariate analyses. Results Between 2002 and 2021, there were 31,552,201 estimated emergency department visits by febrile children aged 2-24 months with recorded temperature >= 38.0 degrees C. In 2002-2012, Hispanic females and non-Hispanic Black females had significantly lower frequencies (13-19% vs. 26%; p < 0.001) compared to non-Hispanic White females. However, urine testing frequencies significantly increased over the study period for Hispanic and non-Hispanic Black females (coefficients of 1.10 and 0.74, respectively; multivariate linear regression tests for trend, p < 0.05). By 2021, there were no racial and ethnic differences in urine testing (p > 0.05). There were no differences among males (p > 0.05). Conclusions Nationally, Hispanic and non-Hispanic Black females had disproportionately lower frequencies of receiving urine tests at the beginning of the study period but had equivalent frequencies to non-Hispanic White females by 2021, suggesting that racial and ethnic disparities have decreased over time. Future research will examine the impact of these trends on disparities in health outcomes.