Racial inequities remain in pediatric lupus care despite overall outcome improvements
Click Here to Manage Email Alerts
Children with lupus of all racial and ethnic groups have experienced reduced of end-stage renal disease and dialysis, but the overall improvement has failed to close the outcome gap between Black and white patients, researchers noted.
“There’s been a big push in recent years to improve pediatric lupus care, so trending population-based outcomes helps us keep our finger on the pulse to ensure that care advances reach all of our patients equitably,” Joyce Chang, MD, MSCE, of Boston Children’s Hospital, told Healio.
“We hypothesized that hospitalizations related to adverse renal outcomes have decreased in the setting of overall advances in pediatric lupus care, and that these changes over time may have affected racial and ethnic minority groups differently,” Chang and colleagues wrote in Arthritis and Rheumatology.
To examine trends in pediatric-onset systemic lupus erythematosus, Chang and colleagues analyzed inpatient admission data from 50 pediatric hospitals — ranging in date from Jan. 1, 2006, though Dec. 31, 2019 — of patients who received a primary or secondary discharge diagnosis for SLE. Patients whose admission lasted less than 24 hours were excluded from the analysis.
A composite measure of adverse renal outcomes — including an end-stage renal disease code, a procedure code for dialysis or a renal transplant — served as the primary outcome. Chang and colleagues used certain combined racial and ethnic categories to account for the occurrence of interactions between the two and the change in reporting over time among Hispanic participants, the authors wrote. The categories included in the analysis were Asian/Pacific Islander, Black, Hispanic other, Hispanic white and non-Hispanic other — including a small number of patients who reported as American Indian — as well as non-Hispanic white, which served as the reference group.
The analysis included 7,434 patients with SLE, among whom 32% were Black, 16% were Hispanic white, 12% were Hispanic other and 8% were Asian/Pacific Islander. The researchers reported a total of 20,893 hospital admission across this population.
According to Chang and colleagues, admission rates declined over time from 0.29% in 2006 to 0.24% in 2019 (P = .001). In total, 667 patients experienced any adverse event In total, 471 patients received at least one end-stage renal disease diagnosis, 566 had one or more procedure codes for dialysis and 162 underwent a transplant during the study period.
Across all racial and ethnic groups, the adjusted likelihood of any adverse renal outcome during any hospital admission decreased by 0.6-fold (95% CI, 0.46-0.79) between 2011 and 2015, and 0.54-fold (95% CI, 0.42-0.68) between 2016 and 2019, according to the researchers.
However, Black patients with SLE had a 2.5-fold higher adjusted likelihood of experiencing an adverse renal outcome at any admission (95% CI, 1.77-3.52), compared with non-Hispanic white patients. In contrast, there was a decrease over time across all groups in the likelihood of patients experiencing any adverse renal outcome at a hospital between 2011 and 2015 (adjusted OR = 0.58; 95% CI, 0.47-0.73) and between 2016 and 2019 (adjusted OR = 0.46; 95% CI, 0.36-.058).
In addition, Black patients with SLE had 1.39-fold higher odds of a first adverse renal event in any calendar period (95% CI, 1.08-1.79), as well as the highest odds of receiving a first end-stage renal disease diagnosis (OR = 1.57; 95% CI, 1.16-2.12), compared with non-Hispanic white patients.
Both Black and Asian children with SLE remained at higher risk for incident adverse renal outcomes, driven by ESRD among Black patients (OR = 1.6; 95% CI, 1.2-2.1) and dialysis among Asian patients (OR = 1.7; 95% CI, 1.1-2.7). Relative disparities did not change significantly over time, the researchers wrote.
“The take-home message is that we’ve made a ton of progress overall in decreasing severe kidney complications, but now it’s time to really focus our efforts on addressing longstanding racial inequities,” Chang said. “This will require both intention and resources, as well as partnerships with policymakers, health system leaders and other pediatric chronic care providers.
“I also think it’s important to acknowledge that there are limitations to this study, and this data does not allow us to understand why the disparities persist,” she added. “There needs to be a fundamental change in how we approach collecting health systems data to ensure that social determinants of health are included.”
Collapse
Click Here to Manage Email Alerts