Sex 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 physician 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 and 12/31/2023. Interventions for participating physicians included an educational lecture and electronic medical record alert. Six-month pre- and postintervention 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 (<i>P</i><0.001), lower height (<i>P</i><0.001), and a greater height deficit (<i>P</i>=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all <i>P</i><0.05). In those with heights <-2 standard deviations (SDs) (n=192) from the mean, there were no significant sex differences; however, Hispanic children continued to have greater height deficit than NHW and NHB children (all <i>P</i><0.02). There was no sex 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%], <i>P</i>=0.002).Conclusion: Disparities in overall short stature referrals were less evident in the subset of children with heights <-2 SD from mean. There was no significant sex bias in GHST, but racial/ethnic disparities remained. Improvement in referring and evaluating females and children from minority groups is still crucial as they remain under referred.