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. 2021 Feb:229:54-60.e2.
doi: 10.1016/j.jpeds.2020.09.052. Epub 2020 Sep 24.

Kawasaki Disease and Clinical Outcome Disparities Among Black Children

Luz A Padilla  1 , Jacqueline L Collins  2 , Adeniyi J Idigo  3 , Yung Lau  2 , Michael A Portman  4 , Sadeep Shrestha  3
Affiliations

Kawasaki Disease and Clinical Outcome Disparities Among Black Children

Luz A Padilla et al. J Pediatr. 2021 Feb.

Abstract

Objective: To determine whether Black children with Kawasaki disease exhibit disparities in prevalence, sequelae, and response to intravenous gamma globulin (IVIG) treatment.

Study design: International Classification of Diseases codes were used to identify children with Kawasaki disease admitted to a tertiary center in the southeastern US. Subjects diagnosed and treated according to American Heart Association criteria were included. Demographic, laboratory, clinical, and echocardiographic data from the electronic medical record (2000-2015) were compared between Blacks and Whites.

Results: Data from 369 subjects (52% Whites and 48% Blacks) were included in our analysis. No significant differences related to timely admission, IVIG treatment, or coronary artery (CA) abnormalities during hospitalization were observed. Blacks showed lower IVIG response rates than Whites for patients administered IVIG within 10 days of fever onset (86.6% vs 95.6%; P = .007). Blacks received more ancillary drugs (9.6% vs 2.6%; P = .003), and endured longer hospitalizations (mean, 5 ± 3.9 days vs 3.4 ± 2.2 days; P = .001). Blacks presented with higher C-reactive protein level and erythrocyte sedimentation rate and lower hemoglobin, albumin, and sodium levels. Blacks had a higher proportion of persistent CA abnormalities than Whites at second follow-up echocardiogram (14.5% vs 6.3%; P = .03), and at third follow-up echocardiogram (21.2% vs 6.9%; P = .01).

Conclusions: Compared with White children, Black children with Kawasaki disease had higher IVIG refractory prevalence, more severe inflammation, more ancillary treatments, and longer hospitalizations. Despite no racial differences in time to diagnosis or initial treatment, there was greater CA abnormality persistence among Black children at follow-up.

Keywords: Black; Kawasaki disease; coronary aneurysm.

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Figures

Figure 1
Figure 1
Flowchart for selecting the clinical cohort of patients with Kawasaki disease analyzed in this study.
Figure 2
Figure 2
Hospital length of stay for patients with Kawasaki disease, by race.
See this image and copyright information in PMC

Comment in

  • Racial disparities in Kawasaki disease are the effect not the cause.
    Kelly MS, James AK. Kelly MS, et al. J Pediatr. 2021 Mar;230:276-277. doi: 10.1016/j.jpeds.2020.11.021. Epub 2020 Nov 22. J Pediatr. 2021. PMID: 33238168 No abstract available.
  • Reply.
    Padilla LA, Portman MA, Shrestha S. Padilla LA, et al. J Pediatr. 2021 Mar;230:277-278. doi: 10.1016/j.jpeds.2020.11.022. Epub 2020 Nov 22. J Pediatr. 2021. PMID: 33238170 No abstract available.

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