medwireNews: Adverse renal outcomes among children hospitalized with systemic lupus erythematosus (SLE) have reduced over the past 13 years, but racial disparities still persist, study findings show.
The results, presented at the ACR Convergence 2021 virtual meeting, indicated that Black children with SLE were a significant 2.5 times more likely than non-Hispanic White children to have an adverse renal outcome at any given hospital admission.
And Black and Asian children were a respective 1.4 and 1.5 times more likely to have an incident hospitalization for an adverse renal outcome. These differences were largely driven by new instances of end-stage renal disease among Black children and dialysis among Asian children.
These racial disparities occurred despite an overall 50% reduction in adverse renal outcomes among children admitted with SLE over time, with similar improvements in each racial/ethnic group, stressed presenting author Joyce Chang (Boston Children’s Hospital, Massachusetts, USA).
The findings are based on 7434 children, aged around 14 years on average, who were discharged with a diagnosis of SLE between 2006 and 2019, during which time there were 20,893 admissions at 50 hospitals for adverse renal outcomes, including end-stage renal disease, a dialysis procedure, or renal transplant.
Among the individuals participating, 32% were Black, 28% were Hispanic other or Hispanic White, 22% were non-Hispanic other, and 8% were Asian. The remainder were non-Hispanic White.
Chang also highlighted that there was no significant change in the magnitude of disparity in overall burden of adverse renal outcomes over time, but there was a significant difference in the magnitude in the 14 hospital catchment areas where Black children comprised more than 50% of the SLE patients.
In these areas, the disparity in risk for adverse renal outcomes widened, from a 1.8-fold risk increase among Black children versus non-Hispanic White children in 2006–2010 to a 7.6-fold increase in 2016–2019.
“Although improving care quality is really important, the focus on improving care quality to reduce treatment variation alone is likely not going to be sufficient to close the gap in racial disparities,” Chang said.
“We actually need to understand the root causes of the racial inequities in order to identify processes that preferentially target improved outcomes among the highest risk groups. The population-based estimates can only provide so much information especially with the type of health data systems that we have today.”
She concluded: “What are more critical are the next steps, which include systematic collection of local data using coordinated efforts at centers on individual and area-level social determinants of health and how these interact with hospital-level care processes and the goal is to understand why there may be differential risks in minority groups and in what local context this occurs so that we can design our hospital care processes around these issues.”
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ACR Convergence 2021; 3–9 November