Introduction: The trajectory of racial and ethnic disparities in pediatric acute respiratory distress syndrome (PARDS) outcomes remain poorly characterized. We aimed to examine changes in PARDS mortality stratified by race and ethnicity since 2016, hypothesizing that mortality disparities will have persisted since 2016. Methods: We performed a retrospective cohort study of children ≤ 18 years with PARDS in the 2016, 2019, and 2022 Healthcare Cost and Utilization Project Kids’ Inpatient Database. PARDS was identified by a published ICD-10 algorithm. Mixed effect logistic regression with hospital as a random effect estimated adjusted odds ratios (aOR) for in-hospital mortality by race and/or ethnicity (reference = White), controlling for age, sex, APR-DRG severity, complex chronic conditions, median ZIP-code income quartile, and hospital type. AI was used for grammatical and statistical code generation assistance. Results: There were 127,398 weighted PARDS admissions (42,831 in 2016; 42,407 in 2019; 42,160 in 2022). In the full cohort, Black (aOR 1.08, 95%CI 1.01-1.15) and “Other race/ethnicity” children (aOR 1.21, 95%CI 1.09-1.34) had increased odds of mortality. Mortality risk for Black children decreased from 2016 (aOR 1.09, 95 % CI 0.99–1.21) to 2019 (aOR 1.02, 0.92–1.13), but rose significantly by 2022 (aOR 1.15, 1.01–1.30). In the Other race/ethnicity group, a progressive, stepwise increase in mortality risk was seen across all three years: 2016 aOR 1.16 (0.96–1.39); 2019 aOR 1.21 (1.04-1.42); 2022 aOR 1.24 (1.03–1.49). Hispanic children demonstrated stable risk across the study period, which was not different from White children. Conclusions: From 2016–2019, risk-adjusted mortality for Black children with PARDS (relative to White) decreased before rebounded sharply in 2022. In contrast, children classified as Other race/ethnicity experienced a steady worsening of mortality throughout the period. Further studies should investigate the association between structural drivers of disparities and mortality for minoritized children and the potential downstream effects of COVID-19 on mortality for Black children given the loss of previous gains in the pre-pandemic period. Urgent work is needed to reverse these disparate outcomes.
Keim et al. (Sun,) studied this question.