Race and Household Income Are Associated With Disease Outcomes in Pediatric Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Hospitalized in the United States.

OBJECTIVE

Race and household income impact outcomes in patients with rheumatic conditions; however, their role in pediatric antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains poorly understood. We aimed to evaluate whether race and ethnicity and household income are associated with severe AAV disease and renal outcomes among pediatric patients in the United States.

METHODS

We used the 2016 and 2019 Kids' Inpatient Database (KID) to identify pediatric AAV hospitalizations. Severe AAV disease was defined by International Classification of Diseases, Tenth Revision codes indicating organ failure, complications, or the use of life-sustaining procedures. We evaluated associations among race and ethnicity and household income quartile with severe disease, end-stage renal disease (ESRD), and renal transplantation among those with ESRD using univariate and multivariable logistic regression.

RESULTS

Among the 673 unweighted AAV hospitalizations, 59% involved at least one severe disease feature. Hispanic race or ethnicity was associated with higher odds of severe disease (adjusted odds ratio [aOR] 1.61; 95% confidence interval [CI] 1.01-2.56) and ESRD (aOR 1.98; 95% CI 1.04-3.77). Among patients with ESRD, those in the lowest-income quartile had significantly lower odds of renal transplantation compared with those in the highest quartile (aOR 0.18; 95% CI 0.04-0.71).

CONCLUSION

In this national sample of hospitalized pediatric patients with AAV, Hispanic race or ethnicity was a statistically significant predictor of severe AAV disease and ESRD, and household income was inversely associated with renal transplantation among those with ESRD. These findings suggest that race and household income may contribute to health inequities in pediatric AAV.