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Risk Factors for Multisystem Inflammatory Syndrome in Children: A Case-control Investigation
Laura D Zambrano1, Michael J Wu1, Lora Martin2
1From the COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is linked to household crowding, large events, and public transit use. These factors, not sociodemographics, increase MIS-C risk in children after SARS-CoV-2 infection.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Previous research indicated non-Hispanic Black children had higher odds of developing MIS-C.
- Sociodemographic factors and underlying medical conditions were adjusted for in prior studies.
- This study investigates patient, household, and community factors contributing to MIS-C risk.
Purpose of the Study:
- To identify specific patient, household, and community exposures associated with Multisystem Inflammatory Syndrome in Children (MIS-C).
- To investigate factors underlying MIS-C likelihood in children following SARS-CoV-2 infection.
- To clarify the relationship between various exposures and MIS-C development.
Main Methods:
- A case-control study involving 275 MIS-C patients and 496 SARS-CoV-2 positive controls hospitalized across 14 US pediatric hospitals in 2021.
- Caregivers completed structured interviews regarding patient/household history and exposures in the month prior to MIS-C hospitalization or SARS-CoV-2 infection.
- Mixed-effects multivariable logistic regression was used to calculate adjusted odds ratios (aOR).
Main Results:
- Race/ethnicity, social vulnerability, and autoimmune history were not associated with MIS-C.
- In previously healthy children, a prior infection hospitalization was linked to increased MIS-C risk (aOR: 4.8).
- Household crowding (aOR: 1.7), large event attendance (aOR: 1.7), school attendance with limited masking (aOR: 2.6), public transit use (aOR: 1.8), and co-resident SARS-CoV-2 infection (aOR: 2.2) were associated with higher MIS-C likelihood, with risk escalating with the number of factors.
Conclusions:
- Caregiver interviews identified specific household and community exposures linked to MIS-C.
- Prior associations between sociodemographic factors and MIS-C were not confirmed in this study.
- Risk for MIS-C increases with the cumulative presence of multiple identified risk factors.
Background:
In a 2020 pilot case-control study using medical records, we reported that non-Hispanic Black children were more likely to develop multisystem inflammatory syndrome in children (MIS-C) after adjustment for sociodemographic factors and underlying medical conditions. Using structured interviews, we investigated patient, household, and community factors underlying MIS-C likelihood.
Methods:
MIS-C case patients hospitalized in 2021 across 14 US pediatric hospitals were matched by age and site to outpatient controls testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 3 months of the admission date. Caregiver interviews queried race/ethnicity, medical history, and household and potential community exposures 1 month before MIS-C hospitalization (case-patients) or after SARS-CoV-2 infection (controls). We calculated adjusted odds ratios (aOR) using mixed-effects multivariable logistic regression.
Results:
Among 275 case patients and 496 controls, race/ethnicity, social vulnerability and patient or family history of autoimmune/rheumatologic disease were not associated with MIS-C. In previously healthy children, MIS-C was associated with a history of hospitalization for an infection [aOR: 4.8; 95% confidence interval (CI): 2.1-11.0]. Household crowding (aOR: 1.7; 95% CI: 1.2-2.6), large event attendance (aOR: 1.7; 95% CI: 1.3-2.1), school attendance with limited masking (aOR: 2.6; 95% CI: 1.1-6.6), public transit use (aOR: 1.8; 95% CI: 1.4-2.4) and co-resident testing positive for SARS-CoV-2 (aOR: 2.2; 95% CI: 1.3-3.7) were associated with increased MIS-C likelihood, with risk increasing with the number of these factors.
Conclusions:
From caregiver interviews, we clarify household and community exposures associated with MIS-C; however, we did not confirm prior associations between sociodemographic factors and MIS-C.
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