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Inpatient outcomes among children with Down syndrome: a Kids' Inpatient Database study
Po-Yang Tsou1, Yu-Hsun Wang2, Ignacio E Tapia3
1Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Farley 4, Boston, MA, USA. po-yang.tsou@childrens.harvard.edu.
Insights
Black children with Down syndrome (DS) face higher risks of mortality and invasive mechanical ventilation (IMV) during hospitalization. These disparities highlight the need for targeted interventions to improve outcomes for this vulnerable population.
Area of Science:
- Pediatric Health
- Genetics and Rare Diseases
- Health Disparities
Background:
- Children with Down syndrome (DS) experience higher rates of multi-system comorbidities and hospitalizations compared to the general population.
- Racial disparities in healthcare access and outcomes are a significant concern in pediatric medicine.
Purpose of the Study:
- To investigate the association between race and hospitalization outcomes, including mortality, in children with Down syndrome.
- To identify if racial differences contribute to variations in critical care utilization and length of stay.
Main Methods:
- Analysis of hospital discharge records from the Kid's Inpatient Database (2006-2019) for children under 21 with DS.
- Primary exposure: Black race. Primary outcomes: Invasive mechanical ventilation (IMV) and mortality. Secondary outcomes: Non-invasive mechanical ventilation (NIMV), length of stay (LOS), and hospitalization cost.
- Multivariable logistic regression models were employed to assess the relationship between Black race and adverse outcomes.
Main Results:
- The study included 163,870 hospitalizations; 9.89% were Black children.
- Black children with DS were more likely to be younger, have lower incomes, public insurance, and a higher burden of comorbidities (e.g., asthma, obesity, congenital heart disease).
- Black race was independently associated with increased mortality (OR: 1.35), IMV (OR: 1.34), NIMV (OR: 1.41), and longer LOS (IRR: 1.08) after multivariable adjustment.
Conclusions:
- Hospitalized Black children with Down syndrome present with distinct demographic and clinical profiles, including higher rates of comorbidities.
- Black children with DS exhibit significantly increased risks for mortality, need for IMV, and prolonged hospital stays.
- Findings underscore critical racial disparities in healthcare outcomes for children with Down syndrome, necessitating further research and targeted interventions.
Background:
Children with Down Syndrome (DS) are more likely to have multi-system comorbidities leading to more frequent hospitalizations than the general population. We aim to evaluate whether racial differences contribute to hospitalization outcomes and mortality among children with DS.
Methods:
Hospital discharge records were obtained for children (< 21 y) with DS hospitalized between 2006 and 2019 from the Kid's Inpatient Database. The primary exposure was the Black race. Primary outcomes were invasive mechanical ventilation (IMV) and mortality. Secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable logistic regression models were used to ascertain associations between Black race and outcomes.
Results:
Among 163,870 hospitalizations in children with DS, 16,208 (9.89%) were Black children. Compared with non-Black children, Black children were younger, of lower household incomes, more likely to have public insurance, more likely to have asthma, OSA, obesity, prematurity, congenital heart disease, pulmonary hypertension, congenital airway anomalies, neuromuscular weakness, and dysphagia. Descriptive analyses indicated that Black race was associated with higher risks of mortality, IMV, NIMV, longer LOS, and greater IACH. After multivariable adjustment, Black race remained independently associated with mortality (OR:1.35, 95%-CI:1.15-1.59, p < 0.0001), IMV (OR:1.34, 95%-CI:1.23-1.45, p < 0.0001), NIMV (OR:1.41, 95%-CI:1.26-1.59, p < 0.0001) and increased LOS (IRR:1.08, 95%-CI:1.04-1.13, p < 0.0001), but not IACH.
Conclusions:
Hospitalized Black children with DS are more likely to be younger, of lower household incomes, with public insurance, and with other underlying comorbidities. Black children had increased risks of mortality and IMV and increased LOS.
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