Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome

Abstract

Objectives: To characterize the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C).

Methods: This multicenter retrospective case-control study was conducted at 3 academic centers from January 1 to September 1, 2020. Children with MIS-C were compared with 5 control groups: children with coronavirus disease 2019, children evaluated for MIS-C who did not meet case patient criteria, children hospitalized with febrile illness, children with Kawasaki disease, and children in Massachusetts based on US census data. Neighborhood socioeconomic status (SES) and social vulnerability index (SVI) were measured via a census-based scoring system. Multivariable logistic regression was used to examine associations between SES, SVI, race and ethnicity, and MIS-C diagnosis and clinical severity as outcomes.

Results: Among 43 patients with MIS-C, 19 (44%) were Hispanic, 11 (26%) were Black, and 12 (28%) were white; 22 (51%) were in the lowest quartile SES, and 23 (53%) were in the highest quartile SVI. SES and SVI were similar between patients with MIS-C and coronavirus disease 2019. In multivariable analysis, lowest SES quartile (odds ratio 2.2 [95% confidence interval 1.1-4.4]), highest SVI quartile (odds ratio 2.8 [95% confidence interval 1.5-5.1]), and racial and/or ethnic minority background were associated with MIS-C diagnosis. Neither SES, SVI, race, nor ethnicity were associated with disease severity.

Conclusions: Lower SES or higher SVI, Hispanic ethnicity, and Black race independently increased risk for MIS-C. Additional studies are required to target interventions to improve health equity for children.

FIGURE 1

A and B, Violin plot of neighborhood SES summary score (A) and SVI (B), including the median and 25th and 75th percentiles in patients with MIS-C versus children (1) with COVID-19, (2) evaluated for MIS-C who did not meet CDC criteria, (3) hospitalized for febrile illness, (4) with KD, and (5) in Massachusetts. In this figure, we compare the distribution of the neighborhood SES summary score and SVI between each group studied. The vertical axis corresponds to the neighborhood SES summary score or the SVI, and the width of each curve corresponds to the frequency of patients within the group with that score or index.