Hispanic children with AAV face higher risk of severe disease: US study
They're also more likely to develop kidney failure than their white counterparts
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Hispanic children and adolescents with ANCA-associated vasculitis (AAV) are significantly more likely to have severe disease and to develop kidney failure than their white counterparts, according to a study in the U.S.
Other predictors of severe AAV and kidney failure included the AAV type microscopic polyangiitis (MPA) and having Medicare coverage, data showed. Among children with kidney failure, the probability of receiving a kidney transplant increased along with household income.
This “study identified significant disparities in the severity of pediatric AAV across race/ethnicity and in renal [kidney] outcomes across estimated income,” researchers wrote.
The study, “Race and Household Income are Associated with Disease Outcomes in Pediatric Patients with ANCA-associated Vasculitis Hospitalized in the United States,” was published in Arthritis Care & Research.
Researchers analyzed data from Kids’ Inpatient Database
AAV is a group of autoimmune diseases characterized by inflammation and damage to small blood vessels, which leads to problems in several organs, including the kidneys. It is typically caused by ANCAs, self-reactive antibodies that bind to proteins on certain immune cells, overly activating them.
Social determinants of health are interconnected circumstances in which individuals live that impact health outcomes, including economic conditions, access to quality healthcare and education, and neighborhood conditions.
“There is currently no literature in pediatric AAV examining the association between socioeconomic status and renal outcomes, such as [kidney failure] or renal transplantation,” the researchers wrote.
In this study, a trio of researchers in the U.S. set out to learn more about the impact of race/ethnicity and household income on disease severity and kidney outcomes among pediatric AAV patients. They analyzed hospitalization data from children and adolescents with AAV using the Kids’ Inpatient Database for the years 2016 and 2019.
Larger proportion of Hispanic children hospitalized for severe disease
A total of 673 hospitalizations were identified and included in the analyses. About two-thirds were reported in girls (63.3%) and in children with the AAV type granulomatosis with polyangiitis (GPA; 67.6%).
Also, the majority of hospitalizations occurred in white children (56.2%), followed by Hispanic (25.7%), Black (9.5%), Native American (1.8%), and Asian or Pacific Islander (1.6%) children.
Most hospitalizations were urgent admissions (85%) and occurred at teaching hospitals (94.8%), while almost half (48%) were covered by private health insurance.
More than half of the hospitalizations (59%) were due to at least one severe clinical feature. Severe disease was defined as organ failure and/or the need for life-supporting interventions, including dialysis (a kidney-replacement treatment) and kidney transplant. There were 190 hospitalizations with coexisting kidney failure, and 38 involved a kidney transplant.
A larger proportion of Hispanic children were hospitalized for severe disease compared with those without severe disease (30.2% vs. 19.2%). In comparison, white children accounted for a smaller proportion of hospitalizations for severe disease (52.4% vs. 61.6%).
MPA, Medicare linked to higher likelihood of kidney failure
Statistical analyses adjusted for potential influencing factors indicated that Hispanic ethnicity was significantly associated with a higher chance of severe disease, by 61%, and kidney failure, by 98%.
Additional factors associated with a two to three times higher chance of severe AAV included being hospitalized in the West region, emergency admissions, having MPA, and being covered by Medicare.
MPA, Medicare, self-paid insurance, and hospitalization in the West region were each significantly associated with a higher likelihood of kidney failure, by two to eight times.
Among those with kidney failure, increasing age was linked to a 32% higher likelihood of kidney transplant, and Native American race to a 14% higher chance.
In addition, the probability of a kidney transplant increased with increasing income, from 8.8% among children at the lowest incomes to 29.1% for those at the highest incomes. Adjusted statistical analysis demonstrated that the lowest incomes were significantly associated with an 82% lower chance of a kidney transplant.
As kidney transplant “is associated with decreased mortality and improved quality of life in those dependent on dialysis, and has become a safer treatment for [kidney failure] over time … the implications of disparate access to [kidney] transplantation are concerning,” the researchers wrote.
