Racial and Ethnic Disparities in Acute Myocarditis Outcomes in the United States

BACKGROUND: Racial and ethnic disparities in cardiovascular outcomes are well established, but whether these inequities extend to acute myocarditis remains insufficiently characterized. HYPOTHESIS: Racial and ethnic minority groups hospitalized with acute myocarditis would have higher odds of in-hospital mortality than White patients. METHODS: Using the National Inpatient Sample from 2012 to 2021, we identified adult hospitalizations with a primary diagnosis of acute myocarditis. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, mechanical circulatory support (MCS), cardiac arrest, ventricular tachycardia/fibrillation (VT/VF), acute kidney injury, renal replacement therapy, and stroke. Multivariable logistic regression estimated adjusted odds ratios (aORs). RESULTS: A total of 105 235 weighted hospitalizations were identified. After adjustment, all minority groups had higher odds of in-hospital mortality than White patients: Black (aOR 1.30, 95% CI 1.10-1.55), Hispanic (aOR 1.37, 95% CI 1.14-1.66), Asian/Pacific Islander (aOR 2.07, 95% CI 1.58-2.72), and Other (aOR 1.40, 95% CI 1.07-1.83). Asian/Pacific Islander patients had the highest odds of cardiogenic shock and MCS use. Black patients had higher odds of cardiac arrest and VT/VF. Hispanic patients had higher in-hospital mortality despite lower odds of VT/VF and MCS use. Race and ethnicity by pandemic era interaction for mortality was not significant (p = 0.072). CONCLUSIONS: Among adults hospitalized with acute myocarditis, racial and ethnic minority groups had higher adjusted odds of in-hospital mortality than White patients. Distinct patterns of complications further underscore the need for equitable, attentive, and risk-informed clinical care.