Gender and racial/ethnic disparities in children presenting for short stature evaluation: in-depth analysis at a single center.

Abstract

Purpose: To assess disparities in children referred for short stature evaluation and to evaluate the effectiveness of interventions on referral rates.

Methods: Retrospective chart review was conducted on children referred to a pediatric endocrinology center for short stature evaluation between 1/1/2022-12/31/2023. Interventions included an educational lecture and electronic medical record alert. Six month pre- and post-intervention referral rates for short stature from a general pediatrics practice were assessed.

Results: There were 747 children (68% males) with a predominance of non-Hispanic White (NHW) children (64%). Females presented at a younger age (P<0.001), with a lower height (P<0.001), and a greater height deficit (P=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all P<0.05). In those with heights <-2 standard deviations (SD) (n=192), there were no significant gender differences however Hispanic children continued to have greater height deficit than NHW and NHB children (all P<0.02). There was no gender difference in those who underwent growth hormone stimulation testing (GHST); however NHW children comprised the largest racial group. After implementing the interventions in the general pediatrics practice, short stature referral rates improved (15 of 118 referrals [13%] to 25 of 81 referrals [31%]; P=0.002).

Conclusions: Disparities in overall short stature referrals were less evident in the subset of children with heights <-2 SD. There was no significant gender bias in GHST but racial/ethnic disparities remained. Improvement in referring and evaluating females and children from minoritized groups is still crucial as they remain under referred.