Race/Ethnicity of COVID-19 Multisystem Inflammatory Syndrome in Children

Quick Takes

  • This study reports a disproportionate burden of MIS-C among Black and Hispanic children in NYC.
  • Additional larger studies are needed to explore the relationship between MIS-C and race/ethnicity and to elucidate any impact of structural racism in maintaining health disparities.
  • Finally, although MIS-C is uncommon, clinicians should be aware of the potential increased risk of this syndrome among Black and Hispanic children.

Study Questions:

What is the distribution of race/ethnicity among multisystem inflammatory syndrome in children (MIS-C) cases reported to the New York City (NYC) Department of Health and Mental Hygiene?

Methods:

The investigators conducted a cohort study of data collected through routine public health surveillance. 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–June 30, 2020; for COVID-19 hospitalizations, the authors included NYC residents <20 years old hospitalized with confirmed SARS-CoV-2 infection during the same period. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for MIS-C and for COVID-19 hospitalizations by race/ethnicity were calculated using SAS statistical software version 9.4.

Results:

The overall MIS-C incidence was 11.4 cases per 100,000 population <20 years old. Although Black children constitute 22.2% of the NYC population and 19.9% of COVID-19 hospitalizations among patients <20 years old, 34.4% of patients with MIS-C (75 patients) were Black. 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 under-represented 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, there was 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.

Conclusions:

The authors concluded that these data suggest a disproportionate burden of MIS-C among Black and Hispanic children in NYC.

Perspective:

This study reports a disproportionate burden of MIS-C among Black and Hispanic children in NYC. It is not clear whether this finding represents a fact distinct from the increased burden of COVID-19 in Black and Hispanic communities, because a disproportionate burden of COVID-19 hospitalizations among Black and Hispanic children has also been reported. Additional larger studies are needed to explore the relationship between MIS-C and race/ethnicity and to elucidate any impact of structural racism in continuing health disparities. Finally, although MIS-C is uncommon, clinicians should be aware of the potential increased risk of this syndrome among Black and Hispanic children.

Clinical Topics: Prevention

Keywords: ACC COVID-19 Podcast, African Americans, Coronavirus, COVID-19, Ethnic Groups, Hispanic Americans, Inflammation, Myocardial Ischemia, Pediatrics, Primary Prevention, Public Health Surveillance, Racism, Receptor, Insulin, severe acute respiratory syndrome coronavirus 2


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