Use of Stigmatizing Language in Pediatric Clinician Notes

BACKGROUND/OBJECTIVES: Stigmatizing language has been identified in 8% of medical notes, disproportionately impacts Black patients, and potentially influences clinician perceptions and care quality. Given prior work has not considered pediatrics as a distinct population, this study quantifies the prevalence of and evaluates for racial differences in stigmatizing language in pediatric notes. METHODS: We conducted a cross-sectional analysis of pediatric notes documented between April 2020 and February 2022 at a large academic medical center. Eleven terms were included after iterative contextual validation. Mixed-effects multivariable logistic regression estimated associations between race and stigmatizing language. Interaction analysis evaluated for effect modification. RESULTS: Among 79 475 pediatric notes, 6.2% contained stigmatizing language. Notes of Black patients had increased odds of stigma compared with white patients (adjusted odds ratio [aOR], 1.35; 95% CI, 1.13-1.61). Effect modification was observed between race and chronic illness and race and age. Compared with notes of white patients without chronic illness, notes of Black patients with chronic illness had higher odds of stigmatizing language (aOR, 1.78; 95% CI, 1.09-2.92). The probability of stigmatizing language increased more rapidly with age for Black compared with white patients, with an absolute difference of 0.5% (95% CI, -0.8% to 1.6%) at 1 year old vs 3.0% (95% CI, 1.2%-4.9%) at 16 years old. CONCLUSIONS: Stigmatizing language occurred in over 6% of pediatric notes and disproportionately impacted notes of Black patients. Disparities were most pronounced among those with chronic illness and increased with age. Clinicians should replace stigmatizing terms with language that identifies specific social barriers and promotes equitable care.