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Published on: July 4, 2007
Racial and ethnic disparities in pediatric autoimmune encephalitis: A systematic review
Jennifer H Yang1, Kristen S Fisher2, Julia Dumcum3
1Department of Neurosciences, University of California San Diego, San Diego, CA USA.
Insights
Research on health disparities in pediatric autoimmune encephalitis (AE) is lacking. More studies are needed to understand how social determinants of health impact AE patient outcomes.
Area of Science:
- Pediatric Neurology
- Autoimmune Diseases
- Health Disparities Research
Background:
- Health disparities and social determinants of health (SDOH) are crucial for understanding clinical outcomes in autoimmune diseases.
- However, research in pediatric autoimmune encephalitis (AE) specifically addressing these factors is limited.
Purpose of the Study:
- To systematically review the existing literature on health disparities and SDOH in pediatric AE.
- To identify gaps in research regarding the impact of these factors on disease outcomes in children.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines, searching major databases up to October 2024.
- Inclusion criteria focused on pediatric AE patients (≤18 years) with reported race/ethnicity, diagnostics, outcomes, and sufficient participant numbers (n≥5).
- Study quality was assessed using the Newcastle-Ottawa scale and the Joanna Briggs Institute Critical Appraisal Checklist.
Main Results:
- Out of 35 included studies, 94% contained pediatric-specific data, but only 34% reported outcomes by racial or ethnic groups.
- Most studies were retrospective cohorts of good or fair quality.
- Crucially, no studies directly compared clinical outcomes between different racial or ethnic groups in pediatric AE.
Conclusions:
- There is a significant lack of rigorous research on health disparities in pediatric autoimmune encephalitis.
- Future research must investigate individual, social, and structural risk factors influencing treatment and long-term outcomes in this population.
Objectives:
Health disparities and social determinants of health are increasingly recognized as important predictors for clinical outcomes in autoimmune disease. However, this is poorly studied in pediatric autoimmune encephalitis (AE).
Methods:
We conducted a systematic literature review in accordance with PRISMA guidelines. Searches included Medline (Pubmed), EMBASE, and Web of Science databases from inception years to October 4, 2024. Inclusion criteria were: 1) Patients diagnosed with AE ≤ 18 years old; 2) any report of race and/or ethnicity, 3) report of specific diagnostics and disease outcomes, 4) observational cohort studies, epidemiological studies or case series/ cohort studies of n ≥ 5 participants. We excluded studies describing only AE associated with viral encephalitis, case reports or case series with <5 cases, papers without clear racial or ethnicity demographics, no report of clinical outcomes, and non-English studies. Study screening, scoring, and data extraction used the Covidence platform. Study quality utilized the Newcastle-Ottawa scale for case-control and cohort studies, and the Joanna Briggs Institute Critical Appraisal Checklist for epidemiological studies. Descriptive analyses were used to summarize study findings.
Results:
A total of 35 studies were included in the study: 74 % retrospective cohort, 14 % prospective cohort, 8.6 % epidemiological, and 1 case-control study. Study quality fell mostly into "good" (45.7 %) or "fair" (37 %), and the remaining 17 % were given "poor" quality scores. Among the included studies, 94 % of the studies had pediatric-specific data from which demographic and clinical information could be extracted. Only 12 (34 %) of studies reported outcomes specific to a racial and/or ethnic group - 7 cohort studies from homogenous populations, 3 epidemiological studies, and 2 reported racial frequencies in cognitive outcomes only. No studies compared clinical outcomes among different racial or ethnic groups.
Discussion:
There is an overall paucity in rigorous studies on health disparities in pediatric AE. Future studies should be aimed at determining individual, social, and structural risk factors that may impact treatment and long-term outcomes.
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