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

• Type of Material: Article
• Authors: Laura D. Zambrano, Centers for Disease Control and Prevention; Kathleen N. Ly, Centers for Disease Control and Prevention; Ruth Link-Gelles, Centers for Disease Control and Prevention; Margaret M. Newhams, Children's Hospital Boston; Manzilat Akande, University of Oklahoma College of Medicine; Michael J. Wu, Centers for Disease Control and Prevention; Leora R. Feldstein, Centers for Disease Control and Prevention; Keiko Tarquinio, Emory University; Leila C. Sahni, Texas Children's Hospital Houston; Becky J. Riggs, Johns Hopkins School of Medicine; Aalok R. Singh, New York Medical College; Julie C. Fitzgerald, University of Pennsylvania Perelman School of Medicine; Jennifer E. Schuster, Children's Mercy Kansas City; John S. Giuliano Jr., Yale School of Medicine; Janet A. Englund, University of Washington School of Medicine; Janet R. Hume, University of Minnesota Twin Cities; Mark W. Hall, Nationwide Children’s Hospital; Christina M. Osborne, University of Colorado School of Medicine; Sule Doymaz, SUNY Downstate Health Sciences University; Courtney M. Rowan, Indiana University School of Medicine; Christopher J. Babbitt, Miller Children's and Women's Hospital of Long Beach; Katharine N. Clouser, Hackensack Meridian School of Medicine; Steven M. Horwitz, Bristol-Myers Squibb; Janet Chou, Children's Hospital Boston; Manish M. Patel, Centers for Disease Control and Prevention; Charlotte Hobbs, Departments of Pediatrics; Adrienne G. Randolph, Children's Hospital Boston; Angela P. Campbell, Centers for Disease Control and Prevention
• Language: English
• Date: 2022-11-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0000000000003689
• Title of Journal or Parent Work: Pediatric Infectious Disease Journal
• Volume: 41
• Issue: 11
• Start Page: 891
• End Page: 898
• Keywords: Humans; Adolescent; Systemic Inflammatory Response Syndrome; COVID-19; Child; SARS-CoV-2; Minority Groups; Case-Control Studies; Pilot Projects; Ethnicity
• Research Categories: Sociology, Ethnic and Racial Studies; Sociology, Public and Social Welfare; Biology, Virology

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.