Racial Disparities in Hospital Mortality Among Pediatric Cardiomyopathy and Myocarditis Patients

Abstract

Racially disparate health outcomes exist for a multitude of populations and illnesses. It is unknown how race and ethnicity impact mortality for children with cardiomyopathy or myocarditis. This retrospective cross-sectional study employed the Kids’ Inpatient Database to analyze 34,617 hospital admissions for patients ≤ 18 years old with cardiomyopathy, myocarditis, or both, without concomitant congenital heart disease. Multivariate logistic regression models investigated the impact of race/ethnicity on in-hospital mortality adjusting for age, calendar year, sex, insurance type, diagnostic category, treatment at a pediatric hospital, and non-cardiac organ dysfunction. African American race and Hispanic ethnicity were independent risk factors for mortality (African American: odds ratio (OR) 1.25, 95% confidence interval (CI) 1.01–1.53 and Hispanic: OR 1.29, 95% CI 1.03–1.60). African American race was also found to be significantly associated with the use of extracorporeal membrane oxygenation (ECMO), mortality while on ECMO, and cardiac arrest. Adjusting the regression model for ECMO and arrest attenuated the impact of African American race on mortality, suggesting that these variables may indeed play a role in explaining the impact of race on mortality for African American patients with myocardial disease. Hispanic ethnicity remained associated with higher risk of mortality despite controlling for all mechanical circulatory support and transplant (OR 1.30, 95% CI 1.04–1.63). Children of racial and ethnic minorities hospitalized with cardiomyopathy or myocarditis are more likely to die than their white counterparts, a trend that may be due at least in part to in-hospital differences in care or response to therapy.

Appendices

Appendix 1

ICD-9 Codes Included for Cardiomyopathy and Myocarditis

Cardiomyopathy

425.0:

Endomyocardial fibrosis

425.1:

Hypertrophic cardiomyopathy

425.11:

Hypertrophic obstructive cardiomyopathy

425.18:

Other hypertrophic cardiomyopathy

425.2:

Obscure cardiomyopathy of Africa

425.3:

Endocardial fibroelastosis

425.4:

Other primary cardiomyopathies

425.5:

Alcoholic cardiomyopathy

425.7:

Nutritional and metabolic cardiomyopathy

425.8:

Cardiomyopathy in other diseases classified elsewhere

425.9:

Secondary cardiomyopathy, unspecified

674.5:

Peripartum cardiomyopathy

Myocarditis

32.82:

Diphtheritic myocarditis

36.43:

Meningococcal myocarditis

74.23:

Coxsackie myocarditis

93.82:

Syphilitic myocarditis

130.3:

Myocarditis due to toxoplasmosis

391.2:

Acute rheumatic myocarditis

420.0:

Acute pericarditis in diseases classified elsewhere

420.9:

Other and unspecified acute pericarditis

420.90:

Acute pericarditis, unspecified

420.91:

Acute idiopathic pericarditis

420.99:

Other acute pericarditis

422.0:

Acute myocarditis in diseases classified elsewhere

422.9:

Other and unspecified acute myocarditis

422.90:

Acute myocarditis, unspecified

422.91:

Idiopathic myocarditis

422.92:

Septic myocarditis

422.93:

Toxic myocarditis

422.99:

Other acute myocarditis

429.0:

Myocarditis, unspecified

Appendix 2

ICD-9 Codes Included for Organ Dysfunction

Cardiac Dysfunction

458.8:

Other specified hypotension

458.9:

Hypotension, unspecified

785.50:

Shock, unspecified

785.51:

Cardiogenic shock

785.52:

Septic shock

785.59:

Other shock without mention of trauma

Respiratory Dysfunction

518.0:

Pulmonary collapse

518.81:

Acute respiratory failure

518.82:

Other pulmonary insufficiency, not elsewhere classified

786.09:

Other respiratory abnormalities

799.1:

Respiratory arrest

(Also included mechanical ventilation as coded in KID).

Neurologic Dysfunction

293.0:

Delirium due to conditions classified elsewhere

293.1:

Subacute delirium

293.8:

Other specified transient mental disorders due to conditions classified elsewhere

293.81:

Psychotic disorder with delusions in conditions classified elsewhere

293.82:

Psychotic disorder with hallucinations in conditions classified elsewhere

293.83:

Mood disorder in conditions classified elsewhere

293.84:

Anxiety disorder in conditions classified elsewhere

293.89:

Other specified transient mental disorders due to conditions classified elsewhere, other

293.9:

Unspecified transient mental disorder in conditions classified elsewhere

348.1:

Anoxic brain damage

348.3:

Encephalopathy, not elsewhere specified

348.30:

Encephalopathy, unspecified

348.31:

Metabolic encephalopathy

348.39:

Other encephalopathy

Hematologic Dysfunction

286.6:

Defibrination syndrome

286.9:

Other and unspecified coagulation defects

287.4:

Secondary thrombocytopenia

287.5:

Thrombocytopenia, unspecified

Hepatic Dysfunction

570:

Acute and subacute necrosis of liver

573.4:

Hepatic infarction

Renal Dysfunction

584:

Acute kidney failure

584.5:

Acute kidney failure with lesion of tubular necrosis

584.6:

Acute kidney failure with lesion of renal cortical necrosis

584.7:

Acute kidney failure with lesion of renal medullary [papillary] necrosis

584.8:

Acute kidney failure with other specified pathological lesion in kidney

584.9:

Acute kidney failure, unspecified