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Racial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States
Mara Leimanis Laurens1,2, Kristen Snyder3, Alan T Davis4,5
1Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, Grand Rapids, MI.
Insights
Critically ill children with cancer in the pediatric intensive care unit (PICU) show racial and ethnic disparities in survival. African American and Hispanic children face higher mortality risks compared to Caucasian children, even after accounting for other factors.
Area of Science:
- Pediatric critical care medicine
- Oncology
- Health disparities research
Background:
- Racial and ethnic disparities in healthcare outcomes are a significant concern.
- Understanding survival differences in critically ill pediatric cancer patients is crucial for equitable care.
Purpose of the Study:
- To investigate survival differences among children of various racial/ethnic groups admitted to the pediatric intensive care unit (PICU) with cancer.
- To identify factors contributing to potential disparities in mortality.
Main Methods:
- Retrospective analysis of a large multicenter dataset (Virtual Pediatric Systems).
- Inclusion of 23,128 PICU admissions from 12,232 unique pediatric oncology patients.
- Statistical analysis using mixed-effects logistic regression, controlling for severity (Pediatric Risk of Mortality III), demographics, and treatment variables.
Main Results:
- Overall mortality was 7.0% (1,610 deaths).
- African American (8.5%) and Hispanic (8.1%) children had significantly higher PICU mortality than Caucasian children (6.3%).
- After controlling for confounders, Hispanic and African American children still had significantly higher odds of mortality.
Conclusions:
- A child's race, ethnicity, and region of presentation significantly influence mortality in the PICU, independent of cancer type and severity.
- These findings highlight the need for further investigation into the underlying causes of these disparities.
- A re-evaluation of the evaluation and treatment approaches for critically ill African American and Hispanic children with cancer is warranted.
Objective:
We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU.
Design:
A retrospective multicenter analysis was conducted using Virtual Pediatric Systems data from reporting centers. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were analyzed using mixed-effects logistic regression modeling to assess for differences in mortality.
Setting:
One hundred thirty-five PICUs in the United States.
Patients:
Pediatric patients with cancer admitted to PICUs in the United States.
Interventions:
None.
Measurements And Main Results:
This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p < 0.05) compared with Caucasian children (6.3%). Regional analysis showed Hispanic patients to have higher mortality in the West in the United States, whereas African American patients in the South in the United States had higher mortality. A pulmonary disease diagnosis in Hispanics increased odds of mortality (odds ratio, 1.39; 95% CI, 1.13-1.70), whereas a diagnosis of shock/sepsis increased risk for mortality in African Americans (odds ratio, 1.56; 95% CI, 1.11-2.20) compared with Caucasians. There were no differences between races/ethnic groups in the rates of limitations of care. After controlling for Pediatric Risk of Mortality III, PICU length of stay, stem cell transplant status, readmissions, cancer type (solid, brain, hematologic), mechanical ventilation days, and sex, Hispanic (odds ratio, 1.24; 95% CI, 1.05-1.47) and African Americans (odds ratio, 1.37; 95% CI, 1.14-1.66) had significantly higher odds of mortality compared with Caucasians.
Conclusions:
The results show that after controlling for severity and cancer type, a child's race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer.
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