Sex and racial/ethnic disparities in children presenting for short stature evaluation: in-depth analysis at a single center.

purposeTo assess disparities in children referred for short stature evaluation and to evaluate the effectiveness of physician interventions on referral rates.

methodsRetrospective 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.

resultsThere were 747 children (68% males) with a predominance of non-Hispanic White (NHW) children (64%). Females presented at a younger age (P<0.001), lower height (P<0.001), and a greater height deficit (P=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all P<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 P<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%], P=0.002).

conclusionDisparities 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.