Buonsenso Danilo, Camporesi Anna, Sawaya Charles, Ulloa-Gutierrez Rolando, Faugier-Fuentes Enrique, Dueñas Lourdes, Paternina-de la Ossa Rolando A, Llamas-Guillén Beatriz A, Gámez-González Luisa B, Gálvez-Rafael Nancy, Gatica Andrea, Saltigeral-Simental Patricia, Cuatecontzi-Romero Adán, Almeida Flávia Jacqueline, Cuan Shirley, Zapata-Yarlequé Elmer H, Beltrán Sandra, Reina-Bautista Erika, Collia Adrián, Ivankovich-Escoto Gabriela, Fernández-Sarmiento Jaime, Tremoulet Adriana H
Area Pediatrica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
Pediatr Pulmonol. 2025 Jan;60(1):e27313. doi: 10.1002/ppul.27313. Epub 2024 Dec 26.
There is growing understanding that Social Determinants of Health (SDH) impact on the outcomes of different pediatric conditions. We aimed to determine whether SDH affect the severity of MIS-C.
Retrospective cohort study, 2021-2023. Children and adolescents with MIS-C younger than 18 years of age fulfilling the MIS-C CDC definition within the REKAMLATINA network were invited to participate. We assessed the impact of SDH on the risk of children with MIS-C to be diagnosed with shock, need of inotropes, respiratory support, transfusion, and death.
Two hundred and seventy seven patients from 30 centers in 13 countries were included. Of them, 241 children from the four most-represented countries were included in the final analysis. Food insecurity, higher distance from a health center, not possessing a private vehicle to transport the patient to hospital, and having a home in poor condition, were associated with low LVEF, need of transfusion, shock, and need for respiratory support, when controlling for age, BMI, and ethnicity. The Score of Social Disadvantage was associated with Shock (OR: 1.35, P: 0.011, 95% CI: 1.07-1.71), Respiratory support (OR: 1.39, P: 0.005, 95% CI: 1.1-1.75), Transfusion (OR: 1.63, P0.013, 95% CI 1.1-2.41), but not death (OR: 0.76, P: 0.38, 95% CI: 0.41-1.40).
Among a large cohort of Latin American children with MIS-C, SDH negatively affect outcomes. These findings reinforce the need for better investigation of the role of SDH in MIS-C and other inflammatory conditions and may guide public health interventions.
人们越来越认识到健康的社会决定因素（SDH）会影响不同儿科疾病的治疗结果。我们旨在确定SDH是否会影响儿童多系统炎症综合征（MIS-C）的严重程度。
2021年至2023年的回顾性队列研究。邀请了REKAMLATINA网络中符合MIS-C美国疾病控制与预防中心定义的18岁以下MIS-C儿童和青少年参与研究。我们评估了SDH对MIS-C儿童被诊断为休克、需要使用血管活性药物、呼吸支持、输血和死亡风险的影响。
纳入了来自13个国家30个中心的277名患者。其中，来自四个最具代表性国家的241名儿童被纳入最终分析。在控制年龄、体重指数和种族因素后，粮食不安全、距离健康中心较远、没有私家车送患者去医院以及居住条件差，与左心室射血分数低、需要输血、休克和需要呼吸支持有关。社会劣势评分与休克（比值比：1.35，P值：0.011，95%置信区间：1.07 - 1.71）、呼吸支持（比值比：1.39，P值：0.005，95%置信区间：1.1 - 1.75）、输血（比值比：1.63，P值0.013，95%置信区间1.1 - 2.41）相关，但与死亡无关（比值比：0.76，P值：0.38，95%置信区间：0.41 - 1.40）。
在一大群患有MIS-C的拉丁美洲儿童中，SDH对治疗结果有负面影响。这些发现强化了对SDH在MIS-C和其他炎症性疾病中作用进行更好研究的必要性，并可能指导公共卫生干预措施。
