Customize your JAMA Network experience by selecting one or more topics from the list below.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Lee EH, Kepler KL, Geevarughese A, et al. Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome. JAMA Netw Open. 2020;3(11):e2030280. doi:10.1001/jamanetworkopen.2020.30280
Reports1-3 suggest that a high proportion of cases of coronavirus disease 2019 (COVID-19)–associated multisystem inflammatory syndrome in children (MIS-C) occur among Black and Hispanic children. However, those published reports lack population-level data to contextualize the racial/ethnic distribution of cases. Here, we describe the distribution of race/ethnicity among MIS-C cases reported to the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and examine incidence rates by race/ethnicity to quantify the burden of MIS-C compared with COVID-19 hospitalizations.
This cohort study involved data collected through routine public health surveillance; it was determined to be minimal risk and exempt by the DOHMH institutional review board. Consent was not required for the use of deidentified data. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
On May 4, 2020, DOHMH required reporting of individuals younger than 21 years hospitalized in NYC with findings suggestive of MIS-C.4 Medical epidemiologists abstracted patient records and linked them to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular and serologic laboratory data. This population-based cohort study included NYC residents meeting the Centers for Disease Control and Prevention MIS-C case definition and admitted from March 1 to June 30, 2020; for COVID-19 hospitalizations, we included NYC residents younger than 20 years hospitalized with confirmed SARS-CoV-2 infection during the same period.5 Data from 163 NYC MIS-C cases were reported previously.3
Demographic and clinical data for individuals meeting the MIS-C criteria were described, and the incidence of MIS-C and of COVID-19 hospitalizations per 100 000 NYC residents younger than 20 years, stratified by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, Asian or Pacific Islander, and multiracial or other), was calculated using 2018 population estimates based on US Census Bureau estimates. Incidence rate ratios (IRRs) and 95% CIs for MIS-C and for COVID-19 hospitalizations by race/ethnicity were calculated using SAS statistical software version 9.4 (SAS Institute).
Among 223 patients meeting the MIS-C criteria, the median (interquartile range) age was 7 (3-12) years, and 127 (57.0%) were male (Table 1). For 50 patients (22.4%) with 1 or more underlying condition, asthma (31 patients [13.9%]) and obesity (20 patients [9.0%]) were the most common conditions. SARS-CoV-2 RNA and/or antibodies were detected in 175 patients (78.5%). For 48 patients (21.5%), SARS-CoV-2 test results were negative or unavailable; these cases were included on the basis of epidemiological criteria. Race/ethnicity information was available for 184 patients (82.5%).
The overall MIS-C incidence was 11.4 cases per 100 000 population younger than 20 years. Although Black children constitute 22.2% of the NYC population and 19.9% of COVID-19 hospitalizations among patients younger than 20 years, 34.4% of patients with MIS-C (75 patients) were Black (Table 2). The proportion of patients with MIS-C who were Hispanic (29.8% [65 patients]) was similar to the NYC population (35.6%), but lower than that for COVID-19 hospitalizations (40.0%). White and Asian or Pacific Islander individuals were underrepresented among MIS-C cases (28 White patients [12.8%] and 12 Asian or Pacific Islander patients [5.5%]) and COVID-19 hospitalizations (99 White patients [13.8%] and 23 Asian or Pacific Islander patients [3.2%]) compared with the NYC population (26.1% White individuals and 12.8% Asian or Pacific Islander individuals). Compared with White children, we observed a higher incidence of MIS-C among Black (IRR, 3.2; 95% CI, 2.0-4.9) and Hispanic (IRR, 1.7; 95% CI, 1.1-2.7) children and no difference among Asian or Pacific Islander children (IRR, 0.9; 95% CI, 0.4-1.7). Black (IRR, 1.7; 95% CI, 1.3-2.2) and Hispanic (IRR, 2.1; 95% CI, 1.7-2.7) children had higher COVID-19 hospitalization rates compared with White children.
We present population-based data highlighting a disproportionate burden of MIS-C among Black and Hispanic children in NYC. It is unclear whether this finding represents a phenomenon distinct from the increased burden of COVID-19 in Black and Hispanic communities, because we also observed a disproportionate burden of COVID-19 hospitalizations among Black and Hispanic children. This analysis is limited by missing race/ethnicity data for most confirmed, nonhospitalized, and nonfatal COVID-19 cases in NYC, which prohibits evaluating the excess burden of MIS-C and COVID-19 hospitalizations among children of color. Furthermore, some patients meeting the MIS-C criteria may have been misclassified or not reported. Larger studies are needed to explore the relationship between MIS-C and race/ethnicity and to elucidate the impact of structural racism in perpetuating health disparities.6 Although MIS-C is uncommon, clinicians should be aware of the potential enhanced risk of this emerging syndrome among Black and Hispanic children.
Accepted for Publication: October 23, 2020.
Published: November 30, 2020. doi:10.1001/jamanetworkopen.2020.30280
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Lee EH et al. JAMA Network Open.
Corresponding Author: Ellen H. Lee, MD, Incident Command System Surveillance and Epidemiology Section, New York City Department of Health and Mental Hygiene, 2 Gotham Center, CN 22A, 42-09 28th St, 6th Flr, Long Island City, NY 11101 (email@example.com).
Author Contributions: Dr Lee and Ms Kepler had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Lee, Kepler, Geevarughese, Paneth-Pollak, Reilly.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Lee.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Kepler, Ngai.
Administrative, technical, or material support: Lee, Paneth-Pollak, Dorsinville.
Supervision: Lee, Ngai.
Conflict of Interest Disclosures: None reported.
Additional Contributions: We are grateful for our ongoing collaboration with New York City pediatric health care practitioners and for the contributions of the New York City Department of Health and Mental Hygiene Multisystem Inflammatory Syndrome in Children team: Mike Antwi, MD, MPH, Vennus Ballen, MD, MPH, Dena Bushman, MSN, MPH, Daniel Eiras, MD, MPH, Maura K. Lash, RN, MPH, Christina Ng, RN, Emma Ruderman, MD, MPH, Julia Schillinger, MD, MSc, Amita Toprani, MD, MPH, and Ann Winters, MD, assisted with hospital outreach, medical record review and abstraction; and Jennifer Baumgartner, MPH, Ana Maria Fireteanu, MPH, Emily McGibbon, MPH, Natasha McIntosh-Beckles, BS, Jyotsna S. Ramachandran, MPH, and Aparna Shankar, MPH, assisted with database development, data management and analysis, and electronic laboratory reporting. All of these individuals are employees of the NYC Department of Health and Mental Hygiene and were not compensated beyond their usual salaries.
Create a personal account or sign in to: