Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities. Methods: This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk factors using mixed effects multivariable logistic regression. Results: We compared 241 MIS-C cases with 817 outpatient SARS-CoV-2-positive at-risk controls. Cases and controls had similar sex, age and U.S. census region distribution. MIS-C patients were more frequently previously healthy, non-Hispanic Black, residing in higher SVI areas, and in the 95th percentile or higher for weight-for-age. In the multivariable analysis, the likelihood of MIS-C was higher among non-Hispanic Black children [adjusted odds ratio (aOR): 2.07; 95% CI: 1.23–3.48]. Additionally, SVI in the 2nd and 3rd tertiles (aOR: 1.88; 95% CI: 1.18–2.97 and aOR: 2.03; 95% CI: 1.19–3.47, respectively) were independent factors along with being previously healthy (aOR: 1.64; 95% CI: 1.18–2.28). Conclusions: In this study, non-Hispanic Black children were more likely to develop MIS-C after adjustment for sociodemographic factors, underlying medical conditions, and weight-for-age. Investigation of the potential contribution of immunologic, environmental, and other factors is warranted.

WITHDRAWN: A gene expression-based diagnostic classifier for identification of severe COVID-19 and multisystem inflammatory syndrome in children (MIS-C)

“…On average, symptoms of MIS-C first present two to four weeks after acute COVID-19 illness and can involve a constellation of respiratory, gastrointestinal, cardiac, renal, dermatologic, and neurological symptoms that in 60% of cases result in hospitalization and possible ICU stay with invasive mechanical ventilation required due to inadequate oxygenation 2 . Diagnosis of MIS-C is challenging due to overlapping clinical features with other hyperinflammatory illnesses, such as Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) 3,4 , and the lack of objective biomarker based diagnostic tests hinders accurate diagnosis and effective management and treatment for this condition 5 . As of August 2022, the CDC has reported 8,798 cases of MIS-C and 71 deaths attributed to MIS-C in children 6 , defined as individuals under 21 years of age.…”

Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis

“…A summary of the methodology, characteristics of findings, presence of racial disparity, quality appraisal, and country of study is presented in Table 3 . All of the reviewed studies employed a quantitative methodology [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and used surveillance data collected from electronic health record systems. The studies were conducted from January 2016 to December 2022.…”

“…Nineteen studies (95%) identified the presence of racial disparities in the occurrence rate of common infectious respiratory diseases, such as SARS-CoV-2 (COVID-19), SARS-CoV-2 (COVID-19)-related illnesses, influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), streptococcus, staphylococcus aureus, and rhinovirus [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], among children in the United States. One study conducted by Perez et al [ 13 ] identified the presence of racial disparities in the occurrence rate of infectious respiratory diseases, such as influenza, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and SARS-CoV-2 (COVID-19), with Blacks or African Americans and Hispanics/Latinos carrying the majority (59%) of the burden of infection.…”

“…Mannheim et al [ 27 ] established that 78% of Black and Hispanic children tested positive for SAR-CoV-2 (COVID-19) and that Black and Hispanic children are more likely to test positive for SAR-CoV-2 (COVID-19) than non-minority racial groups. A study by Zambrano et al [ 22 ] established that Black children have a higher likelihood of experiencing severe SARS-CoV-2 (COVID-19) outcomes. A study conducted in Mississippi by Hobbs et al [ 23 ] revealed that Black children constituted 66% of sudden SARS-CoV-2 (COVID-19) hospitalizations from March 2020 to February 2021 at the University of Mississippi Medical Center.…”

“…In this systematic review and meta-analysis, there was strong evidence to support the potential relationship between racial disparities and common infectious respiratory diseases in children. Higher rates of poverty among Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children compared to White children seem to contribute to racial gaps in the occurrence of common infectious respiratory diseases [ 20 , 21 , 22 , 31 ]. Factors related to living in poverty result in increased risks of disease occurrence because Black and Hispanic children often live in multifamily dwellings, with limited financial means and no insurance [ 18 , 24 , 28 , 30 , 31 ].…”