Kawasaki Disease and Clinical Outcome Disparities among Black Children

Study design: ICD codes were used to identify children with Kawasaki disease admitted to a tertiary Southeast U.S. center. Subjects diagnosed and treated according to AHA criteria were included. Demographic, laboratory, clinical and echocardiographic data from EMR (2000-2015) were compared between Blacks and Whites.

Results: Data from 369 subjects (52% Whites and 48% Blacks) were included in our analysis. No significant differences related to timely admission, IVIG treatment or, coronary artery abnormalities during hospitalization were observed, Blacks showed lower IVIG response rates for those administered IVIG within 10 days of fever onset (86.6% vs 95.6%, P = 0.007). Blacks received more ancillary drugs (9.6% vs 2.6%, P value 0.003), and endured longer hospitalizations (5±3.9 vs 3.4±2.2 days, P = 0.001). Blacks presented with higher C-reactive protein, erythrocyte sedimentation rate and; lower hemoglobin, albumin and, sodium. Blacks showed a greater proportion of persistent coronary artery abnormalities at follow-up when compared with Whites (14.5% vs 6.3%, P = .03, second follow-up ECHO; 21.2% vs 6.9%, P = 0.01 third follow-up ECHO).

Conclusion: Black children with Kawasaki disease had higher IVIG refractory prevalence, severe inflammation, received more ancillary treatments and, longer hospitalizations than White children. Despite no racial differences in time to diagnosis or initial treatment, there was higher coronary artery abnormality persistence among Black children at follow-up.

Keywords: Black; Coronary Aneurysms; Kawasaki Disease.