Racial Disparities in Hospital Mortality Among Pediatric Cardiomyopathy and Myocarditis Patients
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ORIGINAL ARTICLE
Racial Disparities in Hospital Mortality Among Pediatric Cardiomyopathy and Myocarditis Patients Jillian Olsen1 · Yuen Lie Tjoeng1 · Joshua Friedland‑Little1 · Titus Chan1 Received: 8 April 2020 / Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Racially disparate health outcomes exist for a multitude of populations and illnesses. It is unknown how race and ethnicity impact mortality for children with cardiomyopathy or myocarditis. This retrospective cross-sectional study employed the Kids’ Inpatient Database to analyze 34,617 hospital admissions for patients ≤ 18 years old with cardiomyopathy, myocarditis, or both, without concomitant congenital heart disease. Multivariate logistic regression models investigated the impact of race/ethnicity on in-hospital mortality adjusting for age, calendar year, sex, insurance type, diagnostic category, treatment at a pediatric hospital, and non-cardiac organ dysfunction. African American race and Hispanic ethnicity were independent risk factors for mortality (African American: odds ratio (OR) 1.25, 95% confidence interval (CI) 1.01–1.53 and Hispanic: OR 1.29, 95% CI 1.03–1.60). African American race was also found to be significantly associated with the use of extracorporeal membrane oxygenation (ECMO), mortality while on ECMO, and cardiac arrest. Adjusting the regression model for ECMO and arrest attenuated the impact of African American race on mortality, suggesting that these variables may indeed play a role in explaining the impact of race on mortality for African American patients with myocardial disease. Hispanic ethnicity remained associated with higher risk of mortality despite controlling for all mechanical circulatory support and transplant (OR 1.30, 95% CI 1.04–1.63). Children of racial and ethnic minorities hospitalized with cardiomyopathy or myocarditis are more likely to die than their white counterparts, a trend that may be due at least in part to in-hospital differences in care or response to therapy. Keywords Race · Mortality · Cardiomyopathy · Myocarditis · Disparity · ECMO
Introduction Previous studies have demonstrated a survival advantage for white patients when compared with their non-white counterparts across a broad range of pediatric conditions [1–6]. Children of racial and ethnic minorities have higher mortality rates than white patients when they carry a diagnosis of congenital heart disease [7, 8], have surgery for congenital heart disease [9–14], or receive a cardiac transplant [15–17]. However, the impact of race and ethnicity on outcomes for pediatric patients with diseases of the myocardium is unknown. It is possible that the racial disparities documented in other subpopulations extend to mortality * Titus Chan [email protected] 1
The Heart Center, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
rates for hospitalized pediatric cardiomyopathy and myocarditis patients. Using a national administ
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