Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-Cov-2 Infection
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.
Zambrano, L. D., Ly, K. N., Link-Gelles, R., Newhams, M. M., Akande, M., Wu, M. J., Feldstein, L. R., Tarquinio, K. M., Sahni, L. C., Riggs, B. J., Singh, A. R., Fitzgerald, J. C., Schuster, J. E., Giuliano, J. S., Englund, J. A., Hume, J. R., Hall, M. W., Osborne, C. M., Doymaz, S., Rowan, C. M., Babbitt, C. J., Clouser, K. N., Horwitz, S. M., Chou, J., Patel, M. M., Hobbs, C., Randolph, A. G., & Campbell, A. P. (2022). Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-Cov-2 Infection. https://doi.org/10.1097/INF.0000000000003689