(328) Beyond Race and Ethnicity: Predictors of Engagement in Pediatric Emergency & Critical Care Research

Introduction: Race/ethnicity (R/E) is a proxy for other factors affecting research engagement. Retrospective studies indicate under- and over-representation of diverse children in research. This study sought to prospectively characterize participation of children at risk for health disparities (CRHD) in emergency and critical care (ECC) research. We hypothesized CRHD would have lower enrollment.

Methods: We collected enrollment and demographic data for eligible participants in 17 ECC studies over 9 months. We defined CRHD as children meeting ≥1 National Institute for Minority Health and Disparities criteria (non-White race, Hispanic ethnicity, non-English speaking, public insurance, low child opportunity index (COI), rural ZIP code). We compared approach and study enrollment for CRHDs vs. non-CRHDs. Study-level consent type, intervention, and risk level were abstracted. Demographic data were collected from coordinators (CRCs) conducting study approaches. Bivariate and multivariable analyses were performed to identify predictors of approach and enrollment.

Results: Of 899 eligible participants, 708 (79%) were CRHD. Overall (CRHD + non-CRHD) approach rates were 77%; enrollment rates were 66%. In bivariate analyses, lower rates of approach were associated with public insurance (78%) vs. private (85%, p=0.02), consent waiver (76%) vs. written (84%, p< 0.001), and approach by a male (74%) vs. female CRC (85%, p< 0.001). Lower enrollment was associated with CRHD status (51% ) vs. non-CRHD (61%, p=0.01), minoritized R/E (50%) vs. white (60%, p=0.01), public insurance (50%) vs. private (60%, p=0.004), low (49%) vs. high COI (58%, p=0.01), consent waiver (38%) vs. written (44%, p=0.01), intervention (36%) vs. observational studies (52%, p= 0.004), and >minimal risk (36%) vs. minimal risk (52%, p=0.04). In multivariable analyses, approach was associated with private insurance (OR=1.39, p=0.059), and female CRC (OR=1.54, p=0.033). Likelihood of enrollment was associated with female CRC (OR=2.93, p < 0.001) and verbal consent vs. waiver (OR=5.08, p=0.02).

Conclusions: Approaches to, and enrollment of, children in ECC research were not associated with CRHD status or R/E. Rather, modifiable factors such as study consent and CRC gender strategies may provide opportunities to advance equity in pediatric research.