Tsou Po-Yang, Wang Yu-Hsun, Tapia Ignacio E
Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Farley 4, Boston, MA, USA.
Center for Children with Special Needs, Tufts Medical Center, Boston, MA, USA.
BMC Pediatr. 2025 Aug 6;25(1):602. doi: 10.1186/s12887-025-05899-9.
Children with Down Syndrome (DS) are more likely to have multi-system comorbidities leading to more frequent hospitalizations than the general population. We aim to evaluate whether racial differences contribute to hospitalization outcomes and mortality among children with DS.
Hospital discharge records were obtained for children (< 21 y) with DS hospitalized between 2006 and 2019 from the Kid's Inpatient Database. The primary exposure was the Black race. Primary outcomes were invasive mechanical ventilation (IMV) and mortality. Secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable logistic regression models were used to ascertain associations between Black race and outcomes.
Among 163,870 hospitalizations in children with DS, 16,208 (9.89%) were Black children. Compared with non-Black children, Black children were younger, of lower household incomes, more likely to have public insurance, more likely to have asthma, OSA, obesity, prematurity, congenital heart disease, pulmonary hypertension, congenital airway anomalies, neuromuscular weakness, and dysphagia. Descriptive analyses indicated that Black race was associated with higher risks of mortality, IMV, NIMV, longer LOS, and greater IACH. After multivariable adjustment, Black race remained independently associated with mortality (OR:1.35, 95%-CI:1.15-1.59, p < 0.0001), IMV (OR:1.34, 95%-CI:1.23-1.45, p < 0.0001), NIMV (OR:1.41, 95%-CI:1.26-1.59, p < 0.0001) and increased LOS (IRR:1.08, 95%-CI:1.04-1.13, p < 0.0001), but not IACH.
Hospitalized Black children with DS are more likely to be younger, of lower household incomes, with public insurance, and with other underlying comorbidities. Black children had increased risks of mortality and IMV and increased LOS.
与普通人群相比，唐氏综合征（DS）患儿更易出现多系统合并症，导致住院频率更高。我们旨在评估种族差异是否会影响DS患儿的住院结局和死亡率。
从儿童住院数据库中获取2006年至2019年间住院的DS患儿（<21岁）的出院记录。主要暴露因素是黑人种族。主要结局是有创机械通气（IMV）和死亡率。次要结局是非侵入性机械通气（NIMV）、住院时间（LOS）和通货膨胀调整后的住院费用（IACH）。采用多变量逻辑回归模型确定黑人种族与结局之间的关联。
在163,870例DS患儿住院病例中，16,208例（9.89%）为黑人儿童。与非黑人儿童相比，黑人儿童年龄更小，家庭收入更低，更有可能拥有公共保险，更有可能患有哮喘、阻塞性睡眠呼吸暂停（OSA）、肥胖、早产、先天性心脏病、肺动脉高压、先天性气道异常、神经肌肉无力和吞咽困难。描述性分析表明，黑人种族与更高的死亡风险、IMV、NIMV、更长的LOS和更高的IACH相关。经过多变量调整后，黑人种族仍然与死亡率（OR：1.35，95%置信区间：1.15 - 1.59，p < 0.0001）、IMV（OR：1.34，95%置信区间：1.23 - 1.45，p < 0.0001）、NIMV（OR：1.41，95%置信区间：1.26 - 1.59，p < 0.0001）以及LOS增加（IRR：1.08，95%置信区间：1.04 - 1.13，p < 0.0001）独立相关，但与IACH无关。
住院的DS黑人儿童更有可能年龄更小、家庭收入更低、拥有公共保险且患有其他潜在合并症。黑人儿童的死亡风险和IMV增加，LOS延长。
