• Laurens Holmes, Isabel Morgan, Brianne Earnest, Alexandra LaHurd, Arie Nettles, and Kirk Dabney.
• Office of Health Equity & Inclusion, Nemours/Alfred I. duPont Hospital for Children, Wilmington/Newark, DE, USA; University of Delaware, Newark, DE, USA. Electronic address: drlholmesjr@gmail.com.
• J Natl Med Assoc. 2018 Dec 1; 110 (6): 583-590.

PurposeVariability in pediatric morbidity and mortality tends to be influenced by several factors including though not limited to social determinants of health, namely health inequity as an exposure function of health disparities. We aimed to assess the cumulative incidence of pediatric mortality, racial/ethnic disparities, and the predisposing factors for the disparities.MethodThe current study retrospectively examined the Nemours/Alfred I. duPont Hospital for Children medical records of 16,121 patients diagnosed with any pediatric condition during 2009 and 2010.ResultsIn-hospital pediatric mortality cumulative incidence was relatively low (80 deaths, 0.49%) when compared with similar settings in the U.S. (national average range, 0.8e1.1%) during the same period. Compared with whites/Caucasians, mortality was higher among blacks/African Americans, prevalence odds ratio (POR), 1.06, 95% CI, 0.77e1.45, and higher for some other race, POR, 1.48, 95% CI, 1.06e2.10. After controlling for potential confounders (severity of illness, insurance status, and length of stay), racial differences in pediatric mortality did not persist between whites and some other race, adjusted POR, 1.08, 99% CI, 0.75e1.57.ConclusionsIn-hospital pediatric mortality cumulative incidence was relatively low in our region, and racial disparities exist but did not persist after controlling for confounders. These findings are suggestive of the importance of social determinants of health namely quality care, adequate medical insurance, and early detection, diagnosis in pediatric morbidity and epigenomic alterations, as well as the need to go beyond the "close medical model" to improve pediatric morbidity and survival by addressing health inequity as a function of health disparities.Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.

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