Social and Demographic Disparities in the Severity of Multisystem Inflammatory Syndrome in Children

Savorgnan, Fabio; Acosta, Sebastián; Alali, Alexander; Moreira, Axel; Annapragada, Ananth; Rusin, Craig G.; Flores, Saúl; Loomba, Rohit S.; Moreira, Álvaro

doi:10.1097/inf.0000000000003511

Cited by 5 publications

(6 citation statements)

References 10 publications

(19 reference statements)

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“…Hence, to quantify the effect of ADI on disease severity, it is important to control for race/ethnicity and weight as covariables in the logistic regression analysis. Savorgnan et al studied 206 children with MIS-C in Texas and determined that Non-Hispanic Black race and high ADI to be associated with severe MIS-C. 9 While our study had similar results about the influence of socioeconomic factors on severe disease, we found only non-Hispanic Asian race (in reference to non-Hispanic White) to be associated with severe disease. One of the reasons for this noted discrepancy could be the small number of non-Hispanic Asians in our cohort which may have impacted our results.…”

Section: Discussionsupporting

confidence: 74%

“…3,7 For example, Savorgnan et al in a study of a large cohort of children in Texas, found an increase in odds of severe MIS-C by 21% for each decile increase in ADI. 9 However, this study was limited due to being conducted in a single state and included only those COVID-19 patients with a diagnosis of MIS-C. Hence the study results are not generalizable to other populations and the entire range of severe COVID-19 infections.…”

mentioning

confidence: 98%

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Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children

Acosta

Suresh

Ettinger

et al. 2023

Pediatric Infectious Disease Journal

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Area deprivation index (ADI) is associated with the risk of severe COVID-19 in adults. However, this association has not been established in children. Information on ADI, demographics, clinical features, disease severity, and outcomes was analyzed for 3434 children with COVID-19. A multivariate logistic regression revealed that non-Hispanic Asians, extremes of weight, and higher ADI were associated with severe disease.

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Section: Discussionsupporting

confidence: 74%

mentioning

confidence: 98%

Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children

Acosta

Suresh

Ettinger

et al. 2023

Pediatric Infectious Disease Journal

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“…As many features of MAS overlap with MIS‐C, it was not possible to classify a specific subgroup of patients with MAS in this registry. Of note, although race, ethnicity, and socioeconomic disadvantage have been associated with disproportionately higher rates of MIS‐C (34,35), as well as more severe presentation (36), they were not significant predictors of early anakinra use to suggest that differential cytokine inhibitor use drives disparities in outcomes. Data from our epidemiologic study provide additional evidence to support current ACR recommendations to reserve cytokine inhibitors for treatment intensification in most hospitalized children with MIS‐C.…”

Section: Discussionmentioning

confidence: 98%

Variation in Early Anakinra Use and Short‐Term Outcomes in Multisystem Inflammatory Syndrome in Children

Chang

Young

Muscal

et al. 2023

Arthritis & Rheumatology

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Objective Evidence regarding effectiveness of interleukin‐1 receptor antagonism in multisystem inflammatory syndrome in children (MIS‐C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy. Methods We conducted a retrospective cohort study of MIS‐C cases in a US surveillance registry from November 2020 to December 2021. Day 0 was the first calendar day of immunomodulatory treatment. Factors associated with initial anakinra use (days 0–1) were identified. We compared cases in patients ages 2–20 years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and/or glucocorticoids on days 0–1, using inverse probability weighting to balance disease severity. Primary outcomes were vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3–4. The secondary outcome was 50% reduction in C‐reactive protein on day 3. Results Among 1,516 MIS‐C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0–74% by site). Site accounted for 59% of residual variance in anakinra use. After balancing disease severity, initial treatment with anakinra plus IVIG and/or glucocorticoids (n = 121) versus IVIG plus glucocorticoids (n = 389) was not associated with significant differences in vasopressor requirement (25.6% versus 20.1%, respectively; risk ratio [RR] 1.27 [95% confidence interval (95% CI) 0.88–1.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98–1.75]), or C‐reactive protein reduction. Conclusion We identified substantial variation in initial anakinra use in a real‐world population of children with MIS‐C, but no average short‐term improvement in cardiovascular outcomes associated with early addition of anakinra to IVIG and/or glucocorticoids compared to IVIG and glucocorticoids alone.

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“…In our previous study, we found that among patients with multisystem inflammatory syndrome in children, non-Hispanic Black children, older patients, and those living in an area with a high deprivation index were significantly more likely to require intubation and vasoactive support (13). These disparities remained after adjustment for sex, BMI, and vaccination status.…”

Section: Discussionmentioning

confidence: 99%

“…Given the widespread use of pulse oximetry for medical decision-making in this cohort of patients and the increased morbidity in Black symptomatic pediatric patients with COVID-19, these patients may be at risk for worse outcomes. However, the weight of this factor on the outcomes is unknown (2, 7, 13).…”

Section: Discussionmentioning

confidence: 99%

Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

Savorgnan

Hassan

Borges

et al. 2023

Pediatric Critical Care Medicine

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Objectives: Pulse oximetry (Spo2) may overestimate arterial oxygen saturation (Sao2) in blood laboratory testing. This study aimed to assess Spo2–Sao2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. Design: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Spo2 and Sao2 data according to approved comparisons. Occult hypoxemia was defined as Spo2 greater than 92% and Sao2 less than 88%. Setting: Quaternary pediatric hospital. Patients: Pediatric COVID-19 patients admitted to Texas Children’s Hospital between May 2020 and December 2021. Interventions: None. Measurements and Main Results: There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients (p < 0.001), and this bias increased as the oxygen saturations decreased (p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively (p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory). Conclusions: We found an oximetry bias in the measurement of Spo2 with respect to Sao2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.

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Social and Demographic Disparities in the Severity of Multisystem Inflammatory Syndrome in Children

Cited by 5 publications

References 10 publications

Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children

Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children

Variation in Early Anakinra Use and Short‐Term Outcomes in Multisystem Inflammatory Syndrome in Children

Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

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