Racial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States*
| Autor: | Mara Leimanis Laurens, Alan T. Davis, Surender Rajasekaran, Richard Hackbarth, Kristen Snyder, Robert K Fitzgerald |
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| Rok vydání: | 2020 |
| Předmět: |
Psychological intervention
Ethnic group Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Logistic regression Odds 03 medical and health sciences 0302 clinical medicine Neoplasms 030225 pediatrics Case fatality rate Ethnicity Risk of mortality Humans Medicine Child Minority Groups Retrospective Studies business.industry Infant 030208 emergency & critical care medicine Retrospective cohort study Odds ratio United States Pediatrics Perinatology and Child Health business Demography |
| Zdroj: | Pediatric Critical Care Medicine. 21:859-868 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000002375 |
| Popis: | OBJECTIVE We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU. DESIGN A retrospective multicenter analysis was conducted using Virtual Pediatric Systems data from reporting centers. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were analyzed using mixed-effects logistic regression modeling to assess for differences in mortality. SETTING One hundred thirty-five PICUs in the United States. PATIENTS Pediatric patients with cancer admitted to PICUs in the United States. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p < 0.05) compared with Caucasian children (6.3%). Regional analysis showed Hispanic patients to have higher mortality in the West in the United States, whereas African American patients in the South in the United States had higher mortality. A pulmonary disease diagnosis in Hispanics increased odds of mortality (odds ratio, 1.39; 95% CI, 1.13-1.70), whereas a diagnosis of shock/sepsis increased risk for mortality in African Americans (odds ratio, 1.56; 95% CI, 1.11-2.20) compared with Caucasians. There were no differences between races/ethnic groups in the rates of limitations of care. After controlling for Pediatric Risk of Mortality III, PICU length of stay, stem cell transplant status, readmissions, cancer type (solid, brain, hematologic), mechanical ventilation days, and sex, Hispanic (odds ratio, 1.24; 95% CI, 1.05-1.47) and African Americans (odds ratio, 1.37; 95% CI, 1.14-1.66) had significantly higher odds of mortality compared with Caucasians. CONCLUSIONS The results show that after controlling for severity and cancer type, a child's race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer. |
| Databáze: | OpenAIRE |
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