Black and Hispanic children are less likely than white children to receive medical imaging tests, such as ultrasounds, MRIs, and X-rays, during emergency department visits, according to a new study by researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.

The findings, published Friday in JAMA Open Network, suggest both an under-use of imaging among minority children and overuse among white children. Researchers attributed the disparity to a range of factors, including bias among doctors whose treatment decisions are influenced by patients’ race.

“Something else is going on here that’s beyond the clinical, that’s beyond the diagnoses,” said Jennifer Marin, an associate professor of pediatrics, emergency medicine, and radiology at Pitt and the study’s lead author.

» READ MORE: Coronavirus has exposed deep race inequity in health care. Can Philadelphia change the trend?

Researchers studied billing data for more than 13 million emergency department visits among children at 52 hospitals in 27 states and the District of Columbia between 2016 and 2019. Even after controlling for factors such as insurance coverage, household income, and diagnosis, researchers found emergency departments ordered far fewer imaging tests for Black and Hispanic children, compared to white children:

  • Black children were 18% less likely than white children to receive medical imaging as part of their emergency department visit.

  • Hispanic children were 13% less likely than white children to receive imaging tests.

Marin said there are several factors that could be contributing to the gap, such as heightened anxiety and demand for testing among white parents, language barriers that result in more or less testing among Hispanic children, and implicit bias among doctors.

Implicit bias is when a doctor’s medical decisions are influenced by unconscious attitudes, beliefs, or stereotypes about people of different races and ethnicity.

Other studies have found that implicit bias often results in minority patients receiving less care and experiencing worse health-care outcomes.

For instance, Black pregnant people are less likely to receive pain medication in labor and more likely to die during childbirth compared to white patients.

Black children diagnosed with type 1 diabetes are less likely than white children to receive advanced technology to help manage their autoimmune condition and experience higher rates of complications.

» READ MORE: Racial bias in health care hurts patients. But that can change.

One major limitation of the study is that billing data cannot help researchers determine how sick children were when they arrived at the emergency department or whether the imaging ordered was necessary. Could white children be receiving more medical imaging because they are sicker when they arrive at the hospital?

Probably not, Marin said. When researchers looked specifically at cases where the child had been discharged from the emergency department — meaning they were not sick enough to be admitted to the hospital — they found even larger racial gaps in testing.

Marin called on hospitals to dig into their own data to see to what extent the trend is playing out in their own emergency departments.

“The first solution is awareness — we’ve brought this to light, there’s clearly a problem. It then becomes important for local emergency departments to look internally at their data,” Marin said. “Really seeing that personalized data can be very eye-opening for physicians. ... I think people would want to know if they’re treating children differently just based on their race.”