Racial Disparities in Hospital Mortality Among Pediatric Cardiomyopathy and Myocarditis Patients

Area of Science:

• Pediatric Cardiology
• Health Disparities Research
• Epidemiology

Background:

• Significant racial and ethnic disparities in health outcomes are well-documented across various diseases.
• The impact of race and ethnicity on mortality in pediatric patients diagnosed with cardiomyopathy or myocarditis remains largely unexamined.

Purpose of the Study:

• To investigate the association between race/ethnicity and in-hospital mortality among children diagnosed with cardiomyopathy or myocarditis.
• To identify potential mediating factors, such as mechanical circulatory support and critical care interventions, that may contribute to observed racial and ethnic disparities in mortality.

Main Methods:

• Retrospective cross-sectional study utilizing the Kids' Inpatient Database (KID).
• Analysis included 34,617 hospital admissions for patients aged 18 years or younger with cardiomyopathy, myocarditis, or both, excluding those with congenital heart disease.
• Multivariate logistic regression models were employed to assess the impact of race/ethnicity on in-hospital mortality, adjusting for covariates including age, sex, insurance, diagnostic category, hospital type, and organ dysfunction.

Main Results:

• Both African American race (OR 1.25, 95% CI 1.01-1.53) and Hispanic ethnicity (OR 1.29, 95% CI 1.03-1.60) were identified as independent risk factors for in-hospital mortality.
• African American race was significantly associated with increased use of extracorporeal membrane oxygenation (ECMO), mortality during ECMO, and cardiac arrest. Adjusting for ECMO and cardiac arrest attenuated the racial disparity in mortality.
• Hispanic ethnicity remained a significant risk factor for mortality even after controlling for mechanical circulatory support and transplant (OR 1.30, 95% CI 1.04-1.63).

Conclusions:

• Children from racial and ethnic minority groups hospitalized with cardiomyopathy or myocarditis exhibit a higher risk of mortality compared to their white counterparts.
• In-hospital care differences or varying responses to therapy may contribute to these observed disparities.
• Further research is warranted to elucidate the mechanisms driving these disparities and to develop targeted interventions to improve outcomes for minority children with these cardiac conditions.