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Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection.
Zambrano, Laura D; Ly, Kathleen N; Link-Gelles, Ruth; Newhams, Margaret M; Akande, Manzilat; Wu, Michael J; Feldstein, Leora R; Tarquinio, Keiko M; Sahni, Leila C; Riggs, Becky J; Singh, Aalok R; Fitzgerald, Julie C; Schuster, Jennifer E; Giuliano, John S; Englund, Janet A; Hume, Janet R; Hall, Mark W; Osborne, Christina M; Doymaz, Sule; Rowan, Courtney M; Babbitt, Christopher J; Clouser, Katharine N; Horwitz, Steven M; Chou, Janet; Patel, Manish M; Hobbs, Charlotte; Randolph, Adrienne G; Campbell, Angela P
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The Pediatric infectious disease journal
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2022-09-07
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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 aged less than 18 years 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 to 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.
Citation
Zambrano LD, Ly KN, Link-Gelles R, Newhams MM, Akande M, Wu MJ, Feldstein LR, Tarquinio KM, Sahni LC, Riggs BJ, Singh AR, Fitzgerald JC, Schuster JE, Giuliano JS Jr, Englund JA, Hume JR, Hall MW, Osborne CM, Doymaz S, Rowan CM, Babbitt CJ, Clouser KN, Horwitz SM, Chou J, Patel MM, Hobbs C, Randolph AG, Campbell AP; Overcoming COVID-19 Investigators. Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection. Pediatr Infect Dis J. 2022 Sep 7. doi: 10.1097/INF.0000000000003689. Epub ahead of print. PMID: 36102740.