Hispanic, Black and poor youngsters are more likely to be diagnosed with multisystem inflammatory syndrome in children (MIS-C) than wealthier, white children, a small new study finds. "The reality is the social context in which these children live means they can be at higher risk for COVID-19 infection, and they can also be at higher risk for worse outcomes once infected," said Dr. Kirsten Bibbins-Domingo, who chairs the epidemiology and biostatistics department at the University of California at San Francisco School of Medicine. The syndrome known as MIS-C is a rare, life-threatening condition seen in children three to four weeks after a COVID-19 infection. Symptoms include fever, severe illness with multisystem organ involvement and laboratory evidence of inflammation. Children diagnosed with MIS-C from January 1, 2020 through September 1, 2020 in three Massachusetts pediatric hospitals were more likely to live in low-income neighborhoods with high social vulnerability and more likely to be Black or Hispanic compared with the general population of children in the state, the study published in Pediatrics found. The retrospective case-control study also found that children living in poorer and less educated communities with more vulnerability regarding housing, transportation and language were at increased risk for both COVID-19 and MIS-C. The study included 43 patients. Their median age was just under 10 years old, and 44% were Hispanic, 16% Black and 16% white. Nineteen, or 44%, had preexisting comorbidities, with 44% obese and 40% asthmatic. "The increased risk of MIS-C appears to be related to an increased risk of COVID-19 infection in those groups," senior author Dr. Audrey Dionne told Reuters Health in an email. A pediatric cardiologist at Boston Children's Hospital, Dionne and her team expected to find an association between race and ethnicity and risk of the syndrome. But they were surprised to find that socioeconomic status also was associated with the risk of MIS-C and that race, ethnicity and socioeconomic status were independently associated with risk. "There are many factors at play," she said. The authors urged pediatricians and public health officials to take steps, such as providing more tests and vaccines, to ameliorate risk for exposure to COVID-19 and thus MIS-C in at-risk communities. In her email, Dionne suggested helping vulnerable populations to minimize exposure to the virus by offering information and treatment in a language that patients and their families understand and by waiving or reducing fees that serve as barriers to care. Previous studies have shown higher rates of SARS-CoV-2 infection in poorer, less educated neighborhoods. In Massachusetts, neighborhoods with more foreign-born residents, bigger household sizes and a high proportion of food-service workers were associated with increased COVID-19 rates. The small number of patients in the new study limited its statistical power. But by including patients from three large pediatric centers the study included the majority, 43, of Massachusetts' 54 MIS-C cases reported to authorities. In the future, Dionne and her co-authors recommend that researchers explore the underlying social, structural, economic, environmental and genetic risk factors for COVID-19 and MIS-C in an effort to develop targeted interventions to support vulnerable children. Bibbins-Domingo, a national leader on ways to prevent health disparities who was not involved with the study, worries about the effects of long COVID-19 and MIS-C in vulnerable communities for years to come. "What is distressing to me is that these same poor and minority communities are going to be the least equipped to deal with sick children in the long term. That is what is hard to fully appreciate," she said in a phone interview. "You have to do the math. Some proportion of people have long-term consequences of long COVID," she said. "We're not focused enough on long COVID." —Ronnie Cohen Source
