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A study of 223 patients under the age of 20 admitted to hospital with the rare but severe COVID-19-related multisystem inflammatory syndrome in children (MIS-C) in New York City found that black children were disproportionately affected.
The population-based cohort study, published today as a research letter in JAMA Network Open, involved analyzing the medical records and laboratory data of all pediatric MIS-C patients reported to the New York City Department of Health and Mental Hygiene from March 1 to June 30.
MIS-C is believed to be an abnormal immune response to the novel coronavirus, similar to but distinct from Kawasaki disease. Although the syndrome was thought to affect only children, a recent study also identified it in adults.
Overall, the incidence of MIS-C was 0.01%. While black children make up 22.2% of the New York City population and 19.9% of COVID-19 pediatric hospitalizations, they made up 34.4% of MIS-C cases. Hispanic children accounted for 29.8% of cases, similar to their proportion of the city’s population (35.6%), although they accounted for 40% of COVID-19 hospitalizations.
In contrast, white children accounted for 12.8% of MIS-C cases and 13.8% of coronavirus hospitalizations, although they made up 26.1% of the city’s population. Similarly, Asians and Pacific Islanders made up only 5.5% of MIS-C cases and 3.2% of COVID-19 hospitalizations, although they accounted for 12.8% of the population.
Breed report, MIS-C
Black children had a higher rate of MIS-C than white children (incidence rate ratio [IRR], 3.2), as well as Hispanic children (IRR, 1.7). Asian and Pacific Island children did not have a significantly different incidence than their white peers. Compared to their white counterparts, black and Hispanic children also had higher COVID-19 hospitalization rates (black IRRs, 1.7; Hispanic IRRs, 2.1).
The mean age of the patients was 7 years and 57% were male. Fifty patients (22.4%) had at least one underlying medical condition, the most common of which were asthma (13.9%) and obesity (9.0%).
The authors said they did not know whether the MIS-C disparities observed in their study are part of the largest health inequalities observed during the COVID-19 pandemic. “It is unclear whether this finding represents a distinct phenomenon from the increased burden of COVID-19 in black and Hispanic communities, because we have also observed a disproportionate burden of COVID-19 hospitalizations among black and Hispanic children,” they wrote.
The researchers called for larger studies to determine the relationship between MIS-C and race and understand the role of structural racism in perpetuating health inequalities, as well as greater vigilance in recognizing the syndrome in non-white children.
“Although MIS-C is rare, physicians should be aware of the potential increased risk of this emerging syndrome among black and Hispanic children,” they said.
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