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. 2025 Aug 6;25(1):602.
doi: 10.1186/s12887-025-05899-9.

Inpatient outcomes among children with Down syndrome: a Kids' Inpatient Database study

Po-Yang Tsou #  1 , Yu-Hsun Wang #  2 , Ignacio E Tapia  3
Affiliations

Inpatient outcomes among children with Down syndrome: a Kids' Inpatient Database study

Po-Yang Tsou et al. BMC Pediatr. .

Abstract

Background: Children with Down Syndrome (DS) are more likely to have multi-system comorbidities leading to more frequent hospitalizations than the general population. We aim to evaluate whether racial differences contribute to hospitalization outcomes and mortality among children with DS.

Methods: Hospital discharge records were obtained for children (< 21 y) with DS hospitalized between 2006 and 2019 from the Kid's Inpatient Database. The primary exposure was the Black race. Primary outcomes were invasive mechanical ventilation (IMV) and mortality. Secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable logistic regression models were used to ascertain associations between Black race and outcomes.

Results: Among 163,870 hospitalizations in children with DS, 16,208 (9.89%) were Black children. Compared with non-Black children, Black children were younger, of lower household incomes, more likely to have public insurance, more likely to have asthma, OSA, obesity, prematurity, congenital heart disease, pulmonary hypertension, congenital airway anomalies, neuromuscular weakness, and dysphagia. Descriptive analyses indicated that Black race was associated with higher risks of mortality, IMV, NIMV, longer LOS, and greater IACH. After multivariable adjustment, Black race remained independently associated with mortality (OR:1.35, 95%-CI:1.15-1.59, p < 0.0001), IMV (OR:1.34, 95%-CI:1.23-1.45, p < 0.0001), NIMV (OR:1.41, 95%-CI:1.26-1.59, p < 0.0001) and increased LOS (IRR:1.08, 95%-CI:1.04-1.13, p < 0.0001), but not IACH.

Conclusions: Hospitalized Black children with DS are more likely to be younger, of lower household incomes, with public insurance, and with other underlying comorbidities. Black children had increased risks of mortality and IMV and increased LOS.

Keywords: Black; Children; Down syndrome.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: KID includes event-level data presented for each admission, and includes diagnostic and procedural codes; the lack of unique identifiers does not allow for identification of repeated admission of the same patients. As all data obtained were deidentified, IRB approval was exempt. Consent for publication: See response in “Ethics approval and consent to participate”. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Construction of the study cohort. Schematic illustration of the construction of the study cohort using the Kids Inpatient Database (KID)
Fig. 2
Fig. 2
Primary diagnostic categories for hospitalizations, expressed as a percentage, based on Clinical Classifications Software (CCS) for children with Down syndrome, stratified by Black race from year 2000 to year 2019. Diagnostic categories expressed as a percentage using the Clinical Classifications Software (CCS) for children with Down syndrome, stratified by Black Children (n=16,208), and non-Black Children (n=147,662)
Fig. 3
Fig. 3
The trend of the mortality rate of Black and non-Black children with Down syndrome hospitalized from year 2000 to year 2019. Schematic illustration of the changes in rates of mortality among hospitalized children with Down syndrome from year 2000 to year 2019. Jonckheere–Terpstra test showed significant changes in trends for all the patients group (p=0.011) and non-Black children (p=0.006), while a non-significant change in trend in mortality for Black children (p=0.453)
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