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Association Between Race/Ethnicity and Severity of Illness in Pediatric Cardiomyopathy and Myocarditis

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Abstract

Introduction: Previous reports demonstrate racial/ethnic differences in survival for children hospitalized with cardiomyopathy and myocarditis. The impact of illness severity, a potential mechanism for disparities, has not been explored. Methods: Using the Virtual Pediatric Systems (VPS, LLC), we identified patients ≤ 18 years old admitted to the intensive care unit (ICU) for cardiomyopathy/myocarditis. Multivariate regression models were used to evaluate the association between race/ethnicity and Pediatric Risk of Mortality (PRISM 3). Multivariate logistic and competing risk regression was used to examine the relationship between race/ethnicity and mortality, CPR, and ECMO. Results: Black patients had higher PRISM 3 scores on first admission (𝛽 = 2.02, 95% CI: 0.15, 3.90). There was no difference in survival across race/ethnicity over multiple hospitalizations. Black patients were less likely to receive a heart transplant (SHR = 0.65, 95% CI: 0.45–0.92). Black and unreported race/ethnicity had higher odds of CPR on first admission (OR = 1.64, 95% CI: 1.01–2.45; OR = 2.12, 95% CI: 1.11–4.08, respectively). Conclusion: Black patients have higher severity of illness on first admission to the ICU, which may reflect differences in access to care. Black patients are less likely to receive a heart transplant. Additionally, Black patients and those with unreported race/ethnicity had higher odds of CPR, which was not mediated by severity of illness, suggesting variations in care may persist after admission.

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Acknowledgements

VPS data was provided by Virtual Pediatric Systems, LLC. No endorsement or editorial restriction of the interpretation of these data or opinions of the authors has been implied or stated.

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Authors and Affiliations

  1. Seattle Children’s Hospital, Division of Pediatric Critical Care, University of Washington, 4800 Sand Point Way NE M/S RC2.820, Seattle, WA, 98105, USA

    Yuen Lie Tjoeng & Titus Chan

  2. Boston Children’s Hospital, Division of Critical Care Medicine, Harvard Medical School, Boston, Massachusetts), USA

    Jillian Olsen

  3. Seattle Children’s Hospital, Division of Pediatric Cardiology, University of Washington, Seattle, Washington), USA

    Joshua M Friedland-Little

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  1. Yuen Lie Tjoeng
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  4. Titus Chan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yuen Lie Tjoeng and Titus Chan. The first draft of the manuscript was written by Yuen Lie Tjoeng and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yuen Lie Tjoeng.

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Tjoeng, Y.L., Olsen, J., Friedland-Little, J.M. et al. Association Between Race/Ethnicity and Severity of Illness in Pediatric Cardiomyopathy and Myocarditis. Pediatr Cardiol 44, 1788–1799 (2023). https://doi.org/10.1007/s00246-023-03203-z

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