Children's Health, Research & Technology

Minority Children with Cancer in PICU’s Show Higher Death Rates

Death rates also vary by region with worse outcomes in the South and West

GRAND RAPIDS, Mich., May 8, 2020 – A new study led by Spectrum Health physician researchers shows that minority children with cancer admitted to pediatric intensive care units (PICUs) throughout the nation have higher death rates than their Caucasian counterparts.

The study found that mortality rates for African American (8.5 percent) and Hispanic children (8.1 percent) are significantly higher compared to Caucasian non-Hispanic children (6.3 percent).

The study also shows that death rates vary by region. In the South, African American patients are significantly more likely to die than Caucasians. In the West, Hispanic patients are more likely to die than their Caucasian counterparts. There are no significant differences reported between any of the racial/ethnic groups and Caucasians in either the Midwest or lower reporting Northeast.

Additionally, certain diagnoses in minorities increased risk for mortality compared to Caucasians. These include pulmonary disease diagnosis in Hispanics and sepsis diagnosis in African Americans.

Senior author Surender Rajasekaran, MD, MPH, is a pediatric intensivist working in critical care medicine, who serves as medical director of research at Spectrum Health Helen DeVos Children’s Hospital. He notes that “Patients with cancer are a very complex and heterogenous group so the researchers controlled for the effect of multiple variables.” These variables included PICU length of stay, stem cell transplant status, readmissions, cancer type, mechanical ventilation days and gender.

“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,” said Rajasekaran. “The primary risk factors for mortality were African American race, Hispanic ethnicity, stem cell transplant status, number of readmissions and need for mechanical ventilation.”

“The major finding of our study is that African American and Hispanic patients with cancer are more likely than Caucasians to die during PICU admission even after accounting for severity,” added Rajasekaran. “We are currently hearing of similar findings when adult patients with COVID are admitted into ICUs. It is vital that we better understand how race and ethnicity influence mortality in ICUs. We hope that our study will trigger more research into the influence of race and ethnicity on mortality.”

According to the study, the higher rates of readmissions and greater mortality in Hispanic and African American children suggest a more complicated and protracted ICU course that could result from a combination of factors both genetic and socioeconomic. However, researchers concluded that the relative contribution of genetic factors versus socioeconomic influences is difficult to determine and beyond the scope of this study.

“The reasons for the discrepancy in outcomes are not completely clear, but it has been suggested that your zip code is more important than your genetic code,” said Rajasekaran. “It is known that issues of social and environmental injustice disproportionately affect African Americans, Hispanics, and other minorities.”

The study suggests that issues of access to care with subsequent delay in diagnosis could explain worse outcomes in minority groups. Historically, the delivery of health care is not equal among all patients, with nearly 21 percent of all children living in poverty. African American or Hispanic children are two to three times more likely to live in poverty than Caucasian children.

The paper, entitled Racial/Ethnic Minority Children with Cancer Experience Higher Mortality on Admission to the ICU in the United States was published online in the journal Pediatric Critical Care Medicine on May 6. It is based on a retrospective multicenter cohort analysis conducted using the Virtual Pediatric Systems (VPS) database, the largest international registry of PICU patients.

VPS contains data from more than 1,000,000 PICU admissions originating from 135 participating centers. For consistency, the study analyzed data from Level 1 United States PICUs with 24/7 in-house attending coverage, an accredited PICU fellowship training program, with unit sizes of more than15 beds and a minimum of 600 admissions per year. All data received from VPS were de-identified.

Information was used for patients with oncological diagnoses on admission from January 2009 to November 2018. The study included admissions from birth to 18 years of age with cancer status described as an active or significant ongoing problem. The study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3 percent of all PICU admissions with 1,610 deaths (7 percent case fatality).

The lead author of the study is research scientist Mara Leimanis Laurens, PhD, of Spectrum Health Helen DeVos Children’s Hospital and Michigan State University College of Human Medicine. Contributing authors include Kristin Snyder, MD, of Children’s Hospital of Philadelphia, Alan T. Davis, PhD, of Spectrum Health and Michigan State University College of Human Medicine, and Robert K. Fitzgerald, MD, and Richard Hackbarth, MD, both of Spectrum Health Helen DeVos Children’s Hospital and Michigan State University College of Human Medicine.



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