Kawasaki Disease and Clinical Outcome Disparities Among Black Children

• Published in: The Journal of pediatrics 2021-02, Vol.229, p.54-60.e2
• Main Authors: Padilla, Luz A., Collins, Jacqueline L., Idigo, Adeniyi J., Lau, Yung, Portman, Michael A., Shrestha, Sadeep
• Format: Article
• Language: English
• Subjects: African Americans; Black; Blood Sedimentation; C-Reactive Protein - analysis; Child, Preschool; coronary aneurysm; Coronary Aneurysm - diagnostic imaging; Echocardiography; European Continental Ancestry Group; Female; Health Status Disparities; Hemoglobins - analysis; Humans; Immunoglobulins, Intravenous - therapeutic use; Kawasaki disease; Length of Stay - statistics & numerical data; Male; Mucocutaneous Lymph Node Syndrome - ethnology; Mucocutaneous Lymph Node Syndrome - therapy; Original; Retrospective Studies; Serum Albumin; Sodium - blood; Southeastern United States - epidemiology
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.09.052

To determine whether Black children with Kawasaki disease exhibit disparities in prevalence, sequelae, and response to intravenous gamma globulin (IVIG) treatment. International Classification of Diseases codes were used to identify children with Kawasaki disease admitted to a tertiary center in the southeastern US. Subjects diagnosed and treated according to American Heart Association criteria were included. Demographic, laboratory, clinical, and echocardiographic data from the electronic medical record (2000-2015) were compared between Blacks and Whites. Data from 369 subjects (52% Whites and 48% Blacks) were included in our analysis. No significant differences related to timely admission, IVIG treatment, or coronary artery (CA) abnormalities during hospitalization were observed. Blacks showed lower IVIG response rates than Whites for patients administered IVIG within 10 days of fever onset (86.6% vs 95.6%; P = .007). Blacks received more ancillary drugs (9.6% vs 2.6%; P = .003), and endured longer hospitalizations (mean, 5 ± 3.9 days vs 3.4 ± 2.2 days; P = .001). Blacks presented with higher C-reactive protein level and erythrocyte sedimentation rate and lower hemoglobin, albumin, and sodium levels. Blacks had a higher proportion of persistent CA abnormalities than Whites at second follow-up echocardiogram (14.5% vs 6.3%; P = .03), and at third follow-up echocardiogram (21.2% vs 6.9%; P = .01). Compared with White children, Black children with Kawasaki disease had higher IVIG refractory prevalence, more severe inflammation, more ancillary treatments, and longer hospitalizations. Despite no racial differences in time to diagnosis or initial treatment, there was greater CA abnormality persistence among Black children at follow-up.