Racial Disparities in Pediatric Anesthesia
An Updated Review
Anesthesiology Clinics
Submitted July 2025 by Dr Megan Wellbeloved
Read by 4 Journal Watch subscribers
This narrative review serves as an update of a previous paper published in 2020 by the same authors. It serves to highlight continued racial disparities in the provision of perioperative care in children.
The authors categorise factors contributing to inequality in health care provision into:
-
Provider factors, highlighting the effect of explicit and implicit bias on the provision of health care and importance of education to help to reduce biases. The authors also discuss the importance of promoting diversity in the workforce.
-
System factors focus on geographic location and the effect on access to surgery. Using standardised protocols may also assist in reducing disparities in perioperative care.
-
Patient/Family factors include socioeconomic status, education level, language and cultural differences, lack of trust in the health care system and multigenerational social and health inequities.
The paper presents a table of recent publications (seven retrospective studies) relevant to paediatric anaesthesia, demonstrating disparities in postoperative mortality, complication rates, analgesic choice, pain scores and analgesic use.
The authors also describe proposed strategies to help to mitigate these racial discrepancies:
- Primarily promotion of diversity amongst paediatric anaesthesia providers and other health care workers.
- Improving diversity in clinical trials.
- Appropriate health care resource allocation.
Although these aforementioned themes carry through globally, it is worth acknowledging more specific concerns within the inequities in healthcare amongst the First Nations and Maori children. Waugh et al presented a review on discrepancies in paediatric anaesthetic care in Australia and New Zealand in 2024 with emphasis on the geographical challenges specific as well as cultural diversity within these two countries (1). This together with a high incidence of chronic disease, surgical pathologies as well as rheumatic heart disease pose significant challenges. Another notable paper on this topic is an editorial in Pediatric Anaesthesia: discussing the imbalance of health care delivery and causative factors including poverty, geographical location, race and gender inequalities (2).
