Racial and/or Ethnic Disparity in Multisystem Inflammatory Syndrome in Children (MIS-C) in the State of Mississippi, USA, July 2020 to June 2021

ABSTRACT

Purpose: The racial composition of Mississippi is Caucasian (C) 58%, African American (AA) 38%, and others 4%, whereas the SARS-CoV-2 PCR positive rates are 16% in AA, 25% in Hispanics, and 6% in C children. We aimed to study the disparities of MIS-C in Mississippi and whether MIS-C follow the same racial distribution as SARS-CoV-2 infection? Methods: Retrospective study of consecutive MIS-C patients <18 years of age hospitalized at our center over 1 year. We compared demographics, clinical presentation, laboratory findings, and treatment of MIS-C by race/ethnicity. We compared the distribution of MIS-C cases with that of SARS-CoV-2 infection rates. Results: During the study period, 51 MIS-C patients hospitalized. Median age was 9 year, 58% male, 36(71%) were AA, 13(25%) were C, 1 was Asian, and 1 was Hispanic. We found a significant delay between onset of symptoms and hospitalization in AA than C children, 2.3±2.1 vs. 0.6±1.5 days (P=0.002). Cardiac symptoms were present in 24%, and 39% had Kawasaki's disease-like symptoms. Only absolute neutrophil count was associated with cardiac dysfunction (p= 0.01) on multivariate analysis. Creatinine and ferritin levels were associated with ICU admission;p= 0.01 and 0.03, respectively. Differences in inflammatory and cardiac biomarkers between AA and C races are summarized in Figure 1. AA children with MIS-C had increased length of hospitalization (8.1 vs 5.2 days;p=0.04), a higher trend of more admissions to ICU (38.9% vs 23.1%;p=0.3) and cardiac involvement (36.1% vs 23.1%;p=0.5) than C Children (Figure 2). Conclusion: In Mississippi, racial disparity in MIS-C exceeds the differences of SARS-CoV-2 infection rates in children. AA children had delayed hospitalization from the onset of symptoms, severe inflammation, longer length of stay, a higher trend for more cardiac dysfunction and ICU admissions than C children. Our findings could assist health professionals in devising appropriate strategies to target minority children.