Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Laura D Zambrano¹, Kathleen N Ly¹, Ruth Link-Gelles^{1

2}, Margaret M Newhams³, Manzilat Akande⁴, Michael J Wu¹, Leora R Feldstein^{1

2}, Keiko M Tarquinio⁵, Leila C Sahni⁶, Becky J Riggs⁷, Aalok R Singh⁸, Julie C Fitzgerald⁹, Jennifer E Schuster¹⁰, John S Giuliano Jr¹¹, Janet A Englund¹², Janet R Hume¹³, Mark W Hall¹⁴, Christina M Osborne¹⁵, Sule Doymaz¹⁶, Courtney M Rowan¹⁷, Christopher J Babbitt¹⁸, Katharine N Clouser¹⁹, Steven M Horwitz²⁰, Janet Chou^{21

22}, Manish M Patel^{1

2}, Charlotte Hobbs^{23

24}, Adrienne G Randolph^{3

22

25}, Angela P Campbell¹; Overcoming COVID-19 Investigators

Affiliations

¹ From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia.
² Public Health Service Commissioned Corps, Rockville, Maryland.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
⁴ Department of Pediatrics-Section of Critical Care, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
⁵ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
⁶ Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Immunization Project, Houston, Texas.
⁷ Department of Anesthesiology and Critical Care Medicine; Division of Pediatric Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
⁸ Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York.
⁹ Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁰ Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
¹¹ Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut.
¹² Department of Pediatrics, School of Medicine, Seattle Children's Research Institute, University of Washington, Seattle, Washington.
¹³ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
¹⁵ Department of Pediatrics, Sections of Critical Care Medicine and Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
¹⁶ Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York.
¹⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana.
¹⁸ Division of Pediatric Critical Care Medicine, Miller Children's and Women's Hospital of Long Beach, Long Beach, California.
¹⁹ Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey.
²⁰ Department of Pediatrics, Division of Critical Care, Bristol-Myers Squibb Children's Hospital, New Brunswick, New Jersey.
²¹ Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
²² Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of.
²³ Pediatrics.
²⁴ Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi.
²⁵ Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.

PMID: 36102740
PMCID: PMC9555608
DOI: 10.1097/INF.0000000000003689

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Laura D Zambrano et al. Pediatr Infect Dis J. 2022.

. 2022 Nov 1;41(11):891-898.

doi: 10.1097/INF.0000000000003689. Epub 2022 Sep 7.

Authors

Affiliations

¹ From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia.
² Public Health Service Commissioned Corps, Rockville, Maryland.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
⁴ Department of Pediatrics-Section of Critical Care, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
⁵ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
⁶ Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Immunization Project, Houston, Texas.
⁷ Department of Anesthesiology and Critical Care Medicine; Division of Pediatric Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
⁸ Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York.
⁹ Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁰ Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
¹¹ Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut.
¹² Department of Pediatrics, School of Medicine, Seattle Children's Research Institute, University of Washington, Seattle, Washington.
¹³ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
¹⁵ Department of Pediatrics, Sections of Critical Care Medicine and Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
¹⁶ Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York.
¹⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana.
¹⁸ Division of Pediatric Critical Care Medicine, Miller Children's and Women's Hospital of Long Beach, Long Beach, California.
¹⁹ Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey.
²⁰ Department of Pediatrics, Division of Critical Care, Bristol-Myers Squibb Children's Hospital, New Brunswick, New Jersey.
²¹ Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
²² Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of.
²³ Pediatrics.
²⁴ Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi.
²⁵ Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.

PMID: 36102740
PMCID: PMC9555608
DOI: 10.1097/INF.0000000000003689

Abstract

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose. Individual ICMJE disclosure forms from authors will be provided.

Figures

**FIGURE 1.**
A: Distribution of social vulnerability index scores, by race and ethnicity. B: Proportion of patients with Medicaid, private insurance, or no insurance/self-pay, by race and ethnicity, among all enrolled patients.

See this image and copyright information in PMC

References

1. Gruber CN, Patel RS, Trachtman R, et al. . Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C). Cell. 2020;183:982–995.e14. - PMC - PubMed
1. Diorio C, Henrickson SE, Vella LA, et al. . Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS–CoV-2. J Clin Invest. 2020;130:5967–5975. - PMC - PubMed
1. Yonker LM, Neilan AM, Bartsch Y, et al. . Pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): clinical presentation, infectivity, and immune responses. J Pediatr. 2020;227:45–52.e5. - PMC - PubMed
1. Sancho-Shimizu V, Brodin P, Cobat A, et al. . SARS-CoV-2–related MIS-C: a key to the viral and genetic causes of Kawasaki disease? J Exp Med. 2021;218:1–16. - PMC - PubMed
1. Whittaker E, Bamford A, Kenny J, et al. . Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324:259–269. - PMC - PubMed

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Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

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Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

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