Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome | Health Disparities | JAMA Network Open | JAMA Network
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Table 1.  Select Characteristics of Cases of MIS-C Among New York City Residents, March 1 to June 30, 2020
Select Characteristics of Cases of MIS-C Among New York City Residents, March 1 to June 30, 2020
Table 2.  MIS-C Cases and COVID-19 Hospitalizations Among New York City Residents Younger Than 20 Years by Race/Ethnicity, March 1 to June 30, 2020
MIS-C Cases and COVID-19 Hospitalizations Among New York City Residents Younger Than 20 Years by Race/Ethnicity, March 1 to June 30, 2020
1.
Toubiana  J, Poirault  C, Corsia  A,  et al.  Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study.   BMJ. 2020;369:m2094. doi:10.1136/bmj.m2094PubMedGoogle ScholarCrossref
2.
Whittaker  E, Bamford  A, Kenny  J,  et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. 2020;324(3):259-269. doi:10.1001/jama.2020.10369PubMedGoogle ScholarCrossref
3.
Godfred-Cato  S, Bryant  B, Leung  J,  et al; California MIS-C Response Team.  COVID-19-associated multisystem inflammatory syndrome in children—United States, March-July 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(32):1074-1080. doi:10.15585/mmwr.mm6932e2PubMedGoogle ScholarCrossref
4.
New York City Department of Health and Mental Hygiene. 2020 Health alert #13: pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Published May 4, 2020. Accessed October 29, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-pediatric-multi-system-inflammatory-syndrome.pdf
5.
Centers for Disease Control and Prevention. Health advisory: multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Published May 14, 2020. Accessed October 29, 2020. https://emergency.cdc.gov/han/2020/han00432.asp
6.
Millett  GA, Jones  AT, Benkeser  D,  et al.  Assessing differential impacts of COVID-19 on black communities.   Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003PubMedGoogle ScholarCrossref
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    Research Letter
    Pediatrics
    November 30, 2020

    Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome

    Author Affiliations
    • 1Incident Command System Surveillance and Epidemiology Section, New York City Department of Health and Mental Hygiene, Long Island City, New York
    JAMA Netw Open. 2020;3(11):e2030280. doi:10.1001/jamanetworkopen.2020.30280
    Introduction

    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.

    Methods

    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).

    Results

    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.

    Discussion

    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.

    Back to top
    Article Information

    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 (elee4@health.nyc.gov).

    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.

    References
    1.
    Toubiana  J, Poirault  C, Corsia  A,  et al.  Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study.   BMJ. 2020;369:m2094. doi:10.1136/bmj.m2094PubMedGoogle ScholarCrossref
    2.
    Whittaker  E, Bamford  A, Kenny  J,  et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. 2020;324(3):259-269. doi:10.1001/jama.2020.10369PubMedGoogle ScholarCrossref
    3.
    Godfred-Cato  S, Bryant  B, Leung  J,  et al; California MIS-C Response Team.  COVID-19-associated multisystem inflammatory syndrome in children—United States, March-July 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(32):1074-1080. doi:10.15585/mmwr.mm6932e2PubMedGoogle ScholarCrossref
    4.
    New York City Department of Health and Mental Hygiene. 2020 Health alert #13: pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Published May 4, 2020. Accessed October 29, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-pediatric-multi-system-inflammatory-syndrome.pdf
    5.
    Centers for Disease Control and Prevention. Health advisory: multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Published May 14, 2020. Accessed October 29, 2020. https://emergency.cdc.gov/han/2020/han00432.asp
    6.
    Millett  GA, Jones  AT, Benkeser  D,  et al.  Assessing differential impacts of COVID-19 on black communities.   Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003PubMedGoogle ScholarCrossref
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