Race affects outcome among infants with intestinal failure

Abstract

Objective: Intestinal failure (IF) is a rare, devastating condition associated with significant morbidity and mortality. We sought to determine whether ethnic and racial differences were associated with patient survival and likelihood of receiving an intestinal transplant in a contemporary cohort of children with IF.

Methods: This was an analysis of a multicenter cohort study with data collected from chart review conducted by the Pediatric Intestinal Failure Consortium. Entry criteria included infants ≤ 12 months receiving parenteral nutrition (PN) for ≥ 60 continuous days and studied for at least 2 years. Outcomes included death and intestinal transplantation (ITx). Race and ethnicity were recorded as they were in the medical record. For purposes of statistical comparisons and regression modeling, categories of race were consolidated into "white" and "nonwhite" children.

Results: Of 272 subjects enrolled, 204 white and 46 nonwhite children were available for analysis. The 48-month cumulative incidence probability of death without ITx was 0.40 for nonwhite and 0.16 for white children (P < 0.001); the cumulative incidence probability of ITx was 0.07 for nonwhite versus 0.31 for white children (P = 0.003). The associations between race and outcomes remained after accounting for low birth weight, diagnosis, and being seen at a transplant center.

Conclusions: Race is associated with death and receiving an ITx in a large cohort of children with IF. This study highlights the need to investigate reasons for this apparent racial disparity in outcome among children with IF.

FIGURE 1

The CIP of death without transplant and transplant, separately for white and non-white children are presented. The x-axis represents time (months) since the enrollment criteria were met, and the y-axis represents the estimated cumulative incidence probabilities.

FIGURE 2

The plots on the first row correspond to CIP among children diagnosed with NEC, and the two plots on the second row correspond to CIP among children with a diagnosis other than NEC. The x-axis represents time (months) since the enrollment criteria were met, and the y-axis represents the estimated cumulative incidence probabilities.

FIGURE 3

The plots on the first row correspond to CIP among children with birth weight ≤ 1.5 kg, and the two plots on the second row correspond to CIP among children with birth weight over 1.5 kg. The x-axis represents time (months) since the enrollment criteria were met, and the y-axis represents the estimated cumulative incidence probabilities.

FIGURE 4

The plots on the first row correspond to CIP among children not evaluated at a PIFCon ITx center, and the plots on the second row correspond to CIP among children seen at a PIFCon ITx center. The x-axis represents time (months) since the enrollment criteria were met, and the y-axis represents the estimated cumulative incidence probabilities.