Kawasaki Disease and Clinical Outcome Disparities Among Black Children

Abstract

Study design ICD codes were used to identify children with Kawasaki disease admitted to a tertiary Southeast U.S. center. Subjects diagnosed and treated according to AHA criteria were included. Demographic, laboratory, clinical and echocardiographic data from EMR (2000-2015) were compared between Blacks and Whites. Results 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 abnormalities during hospitalization were observed, Blacks showed lower IVIG response rates for those administered IVIG within 10 days of fever onset (86.6% vs 95.6%, P = 0.007). Blacks received more ancillary drugs (9.6% vs 2.6%, P value 0.003), and endured longer hospitalizations (5±3.9 v s 3.4±2.2 days, P = 0.001). Blacks presented with higher C-reactive protein, erythrocyte sedimentation rate and; lower hemoglobin, albumin and, sodium. Blacks showed a greater proportion of persistent coronary artery abnormalities at follow-up when compared with Whites (14.5% vs 6.3%, P = .03, second follow-up ECHO; 21.2% vs 6.9%, P = 0.01 third follow-up ECHO). Conclusion Black children with Kawasaki disease had higher IVIG refractory prevalence, severe inflammation, received more ancillary treatments and, longer hospitalizations than White children. Despite no racial differences in time to diagnosis or initial treatment, there was higher coronary artery abnormality persistence among Black children at follow-up.

Coronary artery lesions in children with Kawasaki disease: status quo and nursing care

“…An epidemiological investigation in Jilin Province shows that the incidence of male children is 1.83 times higher than that of female children (20). At present, the incidence of Kawasaki disease in male children is higher than that in female children in most studies, but there is no significant difference in coronary artery disease between the male and female children in some reports (21)(22)(23). Haijian et al (24) found that the male-to-female ratio of children with Kawasaki disease aged less than 6 months can reach 9:1.…”

The role of mitochondria in the pathogenesis of Kawasaki disease

“…Even the incidence in American children of Japanese or African American descent significantly exceeds that of Caucasian descent ( 64 ). Compared with Caucasian children, African American children with KD have more severe inflammation and extended hospitalizations ( 65 ). Previous reports attributed these racial disparities to differences in socioeconomic and environmental factors ( 66 ).…”

Pharmacogenomics of intravenous immunoglobulin response in Kawasaki disease

“…Ethnic or regional differences in treatment response are difficult to discern from literature due to practice variations and often unclear or divergent definitions for outcome parameters including IVIG resistance. Some studies show that children with Hispanic or African American ancestry demonstrate higher rates of IVIG resistance than comparable populations with European or East Asian ancestry ( 18 , 19 ).…”