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Observational Study
. 2021 Dec;106(12):1218-1225.
doi: 10.1136/archdischild-2020-320388. Epub 2021 Mar 16.

Post-COVID-19 paediatric inflammatory multisystem syndrome: association of ethnicity, key worker and socioeconomic status with risk and severity

Jonathan Broad  1   2 , Julia Forman  3 , James Brighouse  4 , Adebola Sobande  5 , Alysha McIntosh  6 , Claire Watterson  6 , Elizabeth Boot  7 , Felicity Montgomery  5 , Iona Gilmour  5 , Joy Tan  5 , Mary Johanna Fogarty  8 , Xabier Gomez  7 , Ronny Cheung  5 , Jon Lillie  7 , Vinay Shivamurthy  4 , Jenny Handforth  6 , Owen Miller  8 ; PIMS-TS study group
Collaborators, Affiliations
Observational Study

Post-COVID-19 paediatric inflammatory multisystem syndrome: association of ethnicity, key worker and socioeconomic status with risk and severity

Jonathan Broad et al. Arch Dis Child. 2021 Dec.

Abstract

Objectives: Patients from ethnic minority groups and key workers are over-represented among adults hospitalised or dying from COVID-19. In this population-based retrospective cohort, we describe the association of ethnicity, socioeconomic and family key worker status with incidence and severity of Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS).

Setting: Evelina London Children's Hospital (ELCH), the tertiary paediatric hospital for the South Thames Retrieval Service (STRS) region.

Participants: 70 children with PIMS-TS admitted 14 February 2020-2 June 2020.

Outcome measures: Incidence and crude ORs are presented, comparing ethnicity and socioeconomic status of our cohort and the catchment population, using census data and Index of Multiple Deprivation (IMD). Regression is used to estimate the association of ethnicity and IMD with admission duration and requirement for intensive care, inotropes and ventilation.

Results: Incidence was significantly higher in children from black (25.0 cases per 100 000 population), Asian (6.4/100 000) and other (17.8/100 000) ethnic groups, compared with 1.6/100 000 in white ethnic groups (ORs 15.7, 4.0 and 11.2, respectively). Incidence was higher in the three most deprived quintiles compared with the least deprived quintile (eg, 8.1/100 000 in quintile 1 vs 1.6/100 000 in quintile 5, OR 5.2). Proportions of families with key workers (50%) exceeded catchment proportions. Admission length of stay was 38% longer in children from black ethnic groups than white (95% CI 4% to 82%; median 8 days vs 6 days). 9/10 children requiring ventilation were from black ethnic groups.

Conclusions: Children in ethnic minority groups, living in more deprived areas and in key worker families are over-represented. Children in black ethnic groups had longer admissions; ethnicity may be associated with ventilation requirement.This project was registered with the ELCH audit and service evaluation team, ref. no 11186.

Keywords: adolescent health; cardiology; epidemiology; statistics; virology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
IMD quintiles by ethnic group.
Figure 2
Figure 2
Key worker/healthcare worker family member in PIMS-TS and comparator populations. Key worker regional comparison: from lowest (Richmond, 1) and highest (Bromley, 2); healthcare comparison England from NHS England workforce data; key worker data from ONS. NHS, National Health Service; ONS, Office for National Statistics; PIMS-TS, Paediatric Inflammatory Multisystem Syndrome, Temporally associated with SARS-CoV-2.
Figure 3
Figure 3
Geographical representation of PIMS-TS cohort by number of cases and district. Adapted with permission from GB Maps. UK Postcode Maps and Vector Editable Outline Postal Code Maps, 2020, published at: www.GBMaps.com (accessed 17 July 2020). PIMS-TS, Paediatric Inflammatory Multisystem Syndrome, Temporally associated with SARS-CoV-2.
Figure 4
Figure 4
Length of stay by ethnic group and IMD quintile. figure S.4 clinical features of patients according to CDC versusWHO versus RCPCH diagnostic criteria. CDC, Centers for Disease Control and Prevention; IMD, Index of Multiple Deprivation; RCPCH, Royal College of Paediatrics and Child Health.
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