Racial Disparities in Renal Outcomes Over Time Among Hospitalized Children With Systemic Lupus Erythematosus

Abstract

Objective Racial and ethnic minority groups have excess morbidity related to renal disease in pediatric‐onset systemic lupus erythematosus (SLE). This study was undertaken to evaluate temporal trends in renal outcomes and racial disparities among hospitalized children with SLE over a period of 14 years. Methods We identified patients 21 years old or younger with discharge diagnoses of SLE in the Pediatric Health Information System inpatient database (2006–2019). Adverse renal outcomes included end‐stage renal disease (ESRD), dialysis, or transplant, analyzed as a composite and separately. We estimated the odds of adverse renal outcomes at any hospitalization or the first occurrence of an adverse renal outcome, adjusted for calendar period, patient characteristics, and clustering by hospital. We tested whether racial disparities differed by calendar period. Results There were 20,893 admissions for 7,434 SLE patients, of which 32%, 16%, 12%, and 8% were Black, Hispanic White, Hispanic Other, and Asian, respectively. Proportions of admissions with adverse renal outcomes decreased over time (P < 0.01). Black children remained at the highest risk of adverse renal outcomes at any admission (odds ratio [OR] 2.5 [95% confidence interval (95% CI) 1.8–3.5] versus non‐Hispanic White patients). Black and Asian children remained at a higher risk of incident adverse renal outcomes, driven by ESRD among Black children (OR 1.6 [95% CI 1.2–2.1]) and dialysis among Asians (OR 1.7 [95% CI 1.1–2.7]). Relative disparities did not change significantly over time. Conclusion Significant reductions in ESRD and dialysis occurred over time for children with SLE across all racial and ethnic groups. The lack of corresponding reductions in racial disparities highlights the need for targeted interventions to achieve greater treatment benefit among higher risk groups.

Health disparities in outcomes of pediatric systemic lupus erythematosus

“…The Southern region of the United States had a significantly larger population of cSLE patients with renal disease (6). This study by Son et (8).…”

Racial and Ethnic Composition of Populations Served by Freestanding Children's Hospitals and Disparities in Outcomes of Pediatric Lupus

“…8 Admissions with <24-hour length of stay and cyclophosphamide infusion codes were considered infusion-only observations and excluded from analysis. 2,9 Study measures. The primary exposures were race and ethnicity for both individual patients and total hospital admissions, collected by each hospital according to local institutional practices.…”

“…We considered race and ethnicity in the following mutually exclusive groups: Asian/Pacific Islander (in any combination except Black), Black in any combination, Hispanic Other race, Hispanic White, non-Hispanic Other race (including a small percentage of patients reported as American Indian), and non-Hispanic White (reference group). 2 Hispanic Other and Hispanic White categories were analyzed separately because of geographic-and hospital-level variation in reporting, as well as a lower-than-expected percentage of individuals reported as both Black and Hispanic, which may be due to how race and ethnicity were collected at each hospital and the likelihood of persons of Afro-Latino descent to self-identify as Black in each setting. Black racial composition and Hispanic ethnic composition of the populations served by each hospital were calculated separately from PHIS reports using the annualized percentage of admissions for any indication comprised by Black and Hispanic patients, respectively.…”

“…1 Racial disparities in adverse renal outcomes among hospitalized children with SLE in the United States (US) have persisted over time, and residual hospital-level variation in renal outcomes remains after accounting for patient-level factors. 2 Because race is a social construct rooted in racism rather than biologic differences, betweenhospital variation in health outcomes suggests that systems-level factors related to where families seek care may drive racial disparities. 3 Deidentified hospital administrative data afford larger representation of pediatric conditions but often lack information about individual-level social determinants of health or other structural factors needed to understand root causes of disparities.…”

An ecological approach to understanding and addressing health inequities of systemic lupus erythematosus

“…These articles predominantly focused on Black women and, to a lesser extent, Latinas. Findings showed these groups have heightened rates of, and risk for, worse health outcomes including pregnancy complication, 22 disease activity and damage accrual, [23][24][25][26][27] worse quality of life, 28,29 multiorgan disease, [30][31][32] and mortality. [33][34][35] They are also at heightened risk for cardiovascular events and After identifying a relevant study, we examined the study's references for relevant articles.…”