Association of race and ethnicity in the receipt of regional anesthesia following mastectomy

2020 ◽  
pp. rapm-2020-101818
Author(s):  
Alexander Beletsky ◽  
Brittany Nicole Burton ◽  
John J Finneran IV ◽  
Brenton S Alexander ◽  
Alvaro Macias ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regional Anesthesia ◽  
Race And Ethnicity ◽  
National Database ◽  
Lower Odds ◽  
Asian Patients ◽  
Multivariable Logistic Regression ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

BackgroundRegional anesthetic techniques have become increasingly used for the purpose of pain management following mastectomy. Although a variety of beneficial techniques have been described, the delivery of regional anesthesia following mastectomy has yet to be examined for racial or ethnic disparities. We aimed to examine the association of race and ethnicity on the delivery of regional anesthesia in patients undergoing surgical mastectomy using a large national database.MethodsWe used the American College of Surgeons–National Surgical Quality Improvement Program database to identify adult patients aged ≥18 years old who underwent mastectomy from 2014 to 2016. We reported unadjusted estimates of regional anesthesia accordingly to race and ethnicity and examined differences in sociodemographic characteristics and health status. Multivariable logistic regression was used to report the association of race and ethnicity with use of regional anesthesia.ResultsA total of 81 345 patients who underwent mastectomy were included, 14 887 (18.3%) of whom underwent regional anesthesia. The unadjusted rate of use of regional anesthesia was 18.9% for white patients, 16.8% for black patients, 15.6% for Asian patients, 16.5% for Native Hawaiian/Pacific Islander patients, 17.8% for American Indian or Alaska Native and 17.4% for unknown race (p<0.001). With respect to ethnicity, the unadjusted rate of regional anesthesia use was 18.4% for non-Hispanic patients vs 16.1% for Hispanic patients vs 18.6% for the unknown ethnicity cohort (p<0.001). On multivariable logistic regression analysis, the odds of receipt of regional anesthesia was 12% lower in black patients and 21% lower in Asian patients compared with white patients (p<0.001). The odds of regional anesthesia use were 13% lower in Hispanic compared with non-Hispanic patients (p<0.001).ConclusionBlack and Asian patients had lower odds of undergoing regional anesthesia following mastectomy compared with white counterparts. In addition, Hispanic patients had lower odds of undergoing regional anesthesia than non-Hispanic counterparts. These differences underlie the importance of working to deliver equitable healthcare irrespective of race or ethnicity.

scholarly journals Racial Disparities in the SOFA Score Among Patients Hospitalized with COVID-19

2021 ◽  
Author(s):  
Benjamin Tolchin ◽  
Carol Oladele ◽  
Deron Galusha ◽  
Nitu Kashyap ◽  
Mary Showstark ◽  
...  
Keyword(s):  
Sofa Score ◽  
Race And Ethnicity ◽  
Research Question ◽  
Standards Of Care ◽  
Medical Resources ◽  
Black Patients ◽  
Hispanic Patients ◽  
Design And Methods ◽  
Hispanic White ◽  
White Patients

AbstractBackgroundSequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care use SOFA score to allocate medical resources during the COVID-19 pandemic.Research QuestionAre SOFA scores disproportionately elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients?Study Design and MethodsRetrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcomes was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6.ResultsOf 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99).InterpretationCrisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

scholarly journals Racial disparities in the SOFA score among patients hospitalized with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257608
Author(s):  
Benjamin Tolchin ◽  
Carol Oladele ◽  
Deron Galusha ◽  
Nitu Kashyap ◽  
Mary Showstark ◽  
...  
Keyword(s):  
Sofa Score ◽  
Race And Ethnicity ◽  
Research Question ◽  
Standards Of Care ◽  
Medical Resources ◽  
Black Patients ◽  
Hispanic Patients ◽  
Design And Methods ◽  
Hispanic White ◽  
White Patients

Background Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. Research question Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? Study design and methods Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. Results Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99). Interpretation Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

scholarly journals Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers

2020 ◽  
Author(s):  
Osagie Ebekozien ◽  
Shivani Agarwal ◽  
Nudrat Noor ◽  
Anastasia Albanese-O’Neill ◽  
Jenise C Wong ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
The United States ◽  
Cross Sectional Study ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Abstract Objective We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites. Method This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level. Results We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P &lt; 0.001, and 9.7 [3.1] vs 8.3 [2.4], P = 0.01, respectively). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs 13%, P &lt; 0.001 and P = 0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95% CI]: 3.7 [1.4, 10.6]). Conclusion We found that among T1D patients with COVID-19 infection, NH Black patients were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Black patients with T1D and COVID-19.

scholarly journals Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

2021 ◽  
Author(s):  
Matthew J. Czarny ◽  
Rani K. Hasan ◽  
Wendy S. Post ◽  
Matthews Chacko ◽  
Stefano Schena ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Black Race ◽  
Transcatheter Aortic Valve ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P <0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P <0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P =0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P <0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P <0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P =0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.

Utilization of glucocorticoids among White and Black patients with systemic lupus erythematosus: Observations from the enrollment visit of a prospective registry

Lupus ◽  
2021 ◽  
pp. 096120332110558
Author(s):  
James K Sullivan ◽  
Emily A Littlejohn
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Health Outcomes ◽  
Lupus Erythematosus ◽  
Cleveland Clinic ◽  
Systemic Lupus ◽  
Black And White ◽  
Black Patients ◽  
White Patients

Background Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to quantify chronic glucocorticoid use among Black and White patients with SLE within a prospective registry. Methods Using enrollment data from a registry at a large academic institution, we compared glucocorticoid use among Black and White patients with SLE. Multivariable logistic regression of race and glucocorticoid use was performed, adjusting for covariates exhibiting a bivariate association with glucocorticoids at significance level p < 0.10. Results 114 White participants (mean age 45; standard deviation (SD) 15) and 59 Black participants (mean age 42; SD 14) were analyzed. White participants had mean SLEDAI-2K score of 3.7 (SD 5.2). Black participants had mean SLEDAI-2K scores of 6.3 (SD 6.0). Among Black participants, 43 (72%) utilized glucocorticoids compared to White participants 39 (34%) (unadjusted odds ratio (OR) 5.17; 95% confidence interval (CI) 2.59–10.33). We did not observe differences between unadjusted hydroxychloroquine (OR 0.69; 95% CI 0.28–1.65) or conventional disease-modifying anti-rheumatic drug (cDMARD) (OR 1.07; 95% CI 0.57–2.01) utilization among Black and White participants. SLEDAI-2K, disability, recent hospitalization, and past or present hydroxychloroquine or cDMARD use were included in a logistic regression model. Adjusting for covariates, Black participants were more likely to be on glucocorticoids (adjusted OR 5.69; 95% CI 2.17–14.96); p = 0.0004). Conclusion Adjusting for disease activity and other medications, Black patients had more exposure to chronic glucocorticoids than White patients in the Cleveland Clinic SLE registry. These patients may face increased glucocorticoid-related morbidity, which could contribute significantly to long-term health outcomes and utilization of health care resources. Future research in larger, more diverse registries should be conducted to further characterize patterns of glucocorticoid use.

scholarly journals Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry

Circulation ◽  
2020 ◽  
Author(s):  
Fatima Rodriguez ◽  
Nicole Solomon ◽  
James A. de Lemos ◽  
Sandeep R. Das ◽  
David A. Morrow ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ethnic Differences ◽  
American Heart ◽  
Disease Registry ◽  
Asian Patients ◽  
Black Patients ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

scholarly journals Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy

2016 ◽  
Vol 34 (36) ◽  
pp. 4398-4404 ◽  
Author(s):  
Alana Biggers ◽  
Yushu Shi ◽  
John Charlson ◽  
Elizabeth C. Smith ◽  
Alicia J. Smallwood ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Hormonal Therapy ◽  
Low Income ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Purpose To investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity. Methods A nationwide cohort of women age ≥ 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments. Results Among the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women. Conclusion Receipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.

scholarly journals Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Samuel T. Savitz ◽  
Thomas Leong ◽  
Sue Hee Sung ◽  
Keane Lee ◽  
Jamal S. Rana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pacific Islander ◽  
Left Ventricular Ejection ◽  
Asian Pacific Islander ◽  
Black Patients ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
White Patients

Background Variation in outcomes by race/ethnicity in adults with heart failure (HF) has been previously observed. Identifying factors contributing to these variations could help target interventions. We evaluated the association of race/ethnicity with HF outcomes and potentially contributing factors within a contemporary HF cohort. Methods and Results We identified members of Kaiser Permanente Northern California, a large integrated healthcare delivery system, who were diagnosed with HF between 2012 and 2016 and had at least 1 year of prior continuous membership and left ventricular ejection fraction data. We used Cox regression with time‐dependent covariates to evaluate the association of self‐identified race/ethnicity with HF or all‐cause hospitalization and all‐cause death, with backward selection for potential explanatory variables. Among 34 621 patients with HF, compared with White patients, Black patients had a higher rate of HF hospitalization (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18–1.38) but a lower rate of death (adjusted HR, 0.78; 95% CI, 0.72–0.85). In contrast, Asian/Pacific Islander patients had similar rates of HF hospitalization, but lower rates of all‐cause hospitalization (adjusted HR, 0.89; 95% CI, 0.85–0.93) and death (adjusted HR, 0.75; 95% CI, 0.69–0.80). Hispanic patients also had a lower rate of death (adjusted HR, 0.85; 95% CI, 0.80–0.91). Sensitivity analyses showed that effect sizes for Black patients were larger among patients with reduced ejection fraction. Conclusions In a contemporary and diverse population with HF, Black patients experienced a higher rate of HF hospitalization and a lower rate of death compared with White patients. In contrast, selected outcomes for Asian/Pacific Islander and Hispanic patients were more favorable compared with White patients. The observed differences were not explained by measured potentially modifiable factors, including pharmacological treatment. Future research is needed to identify explanatory mechanisms underlying ongoing racial/ethnic variation to target potential interventions.

scholarly journals Unsafe child feces disposal status in Ethiopia: what factors matter? analysis of pooled data from four demographic and health surveys

2020 ◽  
Author(s):  
Biniyam Sahiledengle
Keyword(s):  
Logistic Regression ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Multivariable Logistic Regression Model ◽  
Lower Odds ◽  
Paternal Education ◽  
Factors Associated ◽  
Pooled Data ◽  
Multivariable Logistic Regression ◽  
Toilet Facility

Abstract Background: The only safest way to dispose of a child’s feces is to help the child use a toilet or, for very young children, to put or rinse their feces into a toilet; whereas all other disposals are considered unsafe (feces put/rinsed into a drain or ditch, bush or thrown into the garbage, buried or left on the ground, and not disposed of). The study aims to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia.Methods: The study is cross-sectional in nature and based on the pooled data from the four rounds of Demographic and Health Surveys (DHS) conducted in Ethiopia (2000-16). Data on child feces disposal practice was collected for all children born during the five years preceding survey. To get detail about the disposal of children’s feces, mothers of under-five children were asked, “The last time passed stools, what was done to dispose of the stools?” with respect to the youngest child born. Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed to identify factors associated with unsafe child feces disposal. Results: The pooled dataset contains data for 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3-79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13-24 months [AOR: 0.68, 95% CI: (0.60-0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60-0.72)] were lower odds of unsafe child’s feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56-0.79)] odds of unsafe child’s feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19-0.29)] that of households lacking such facilities. Further, being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age (25-34 and ≥ 35 years) were factors associated with lower odds of unsafe child's feces disposal.Conclusions: Three in four Ethiopian children feces disposed of unsafely. Household and socio-demographic factors, such as access to improved water and toilet facility, area of a resident (urban), the child’s age (older age), and both higher maternal and paternal education levels were significantly associated with lower odds of unsafe child feces disposal.

scholarly journals Unsafe child feces disposal status in Ethiopia: what factors matter? analysis of pooled data from four demographic and health surveys

2020 ◽  
Author(s):  
Biniyam Sahiledengle
Keyword(s):  
Logistic Regression ◽  
Urban Areas ◽  
Demographic And Health Surveys ◽  
Multivariable Logistic Regression Model ◽  
Lower Odds ◽  
Paternal Education ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
Toilet Facility ◽  
High Level

Abstract Background: Unsafe child feces disposal has compounding effects on children’s wellbeing. In Ethiopia and many other countries, still, there is a common misconception that children’s feces are not harmful, and not end up in a toilet. Objective: The study aims to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia. Methods: The study is cross-sectional in nature and the analysis was based on data from 1st to 4th rounds of the population-based Ethiopian Demographic and Health Survey (EDHS) conducted between 2000 and 2016. Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed, adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify factors associated with unsafe child feces disposal. Results: The pooled dataset contained information on 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3-79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13-24 months [AOR: 0.68, 95% CI: (0.60-0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60-0.72)] were lower odds of unsafe child’s feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56-0.79)] odds of unsafe child’s feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19-0.29)] that of households lacking such facilities. Being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age were factors associated with lower odds of unsafe child's feces disposal. Conclusions: Three in four Ethiopian children feces disposed of unsafely. Unsafe child feces disposal is less prevalent among households that had improved water and toilet facility, those in urban areas, those with older children, those with a high level of maternal and paternal education, and those with a lower number of under-five children. There is a need for more attention to be paid to curtail the significant burden of unsafe child feces disposal in Ethiopia.

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