African American and Hispanic children admitted to pediatric intensive care units for cancer treatment have significantly higher death rates than do Caucasian patients, a study led by two Michigan State University and Spectrum Health researchers found.
Nationwide, 8.5% of African American and 8.1% of Hispanic children with cancer died after admission to pediatric intensive care units, compared with 6.3% of non-Hispanic Caucasian children.
“I was surprised in some ways that it was such a stark difference,” said senior author Surender Rajasekaran, a physician and assistant professor in the Michigan State University College of Human Medicine and medical director of research at Spectrum Health Helen DeVos Children’s Hospital. “This is an indication of the magnitude of the problem.”
Co-author Mara Leimanis Laurens, a research scientist at DeVos Children’s Hospital and a College of Human Medicine adjunct professor, said the study points out the need for further research to correct the racial and ethnic inequities.
“I don’t want this information to stay on the page,” she said. “It has to lead to something actionable.”
The study, Racial/Ethnic Minority Children with Cancer Experience Higher Mortality on Admission to the ICU in the United States, was published in the journal Pediatric Critical Care Medicine. The researchers drew information from a nationwide Virtual Pediatric Systems database covering 12,232 patients and 23,128 intensive care admissions between 2009 and 2018.
While genetics and environmental exposures might account for some of the higher mortality rates among African Americans and Hispanics, Rajasekaran and Laurens suspect that socioeconomic factors, including poverty and lack of access to primary care, are more significant. Nearly 21% of all children in the U.S. live in poverty, but the rate among African American and Hispanic children is two to three times higher.
Without access to primary care, many African American and Hispanic children likely are in more advanced stages of cancer or critical illness by the time they are admitted to pediatric intensive care units, the researchers suspect. Disparities in health care have been well known among physicians and health care researchers for years and have gotten more general attention in recent months.
“We’re in the era of COVID-19, where this topic has been brought to light,” Laurens said.
The study found regional differences in death rates, with Hispanic children in the Western states and African American children in the Southern states dying at higher rates than Caucasians. Those differences might be due to the large number of new immigrants in the West and a larger portion of African Americans living in rural areas of the South. The study found no statistically significant differences in death rates among the racial and ethnic groups in the Midwest and Northeast.
Minority patients diagnosed with certain diseases — such as pulmonary diseases among Hispanics and sepsis among African Americans in addition to cancer — also had higher death rates than Caucasians with the same diagnoses.
Rajasekaran said the findings point out the need for physicians not only to treat diseases, but to understand their patients’ entire situations.
“Health is more than treating a disease,” he said. “Health is understanding where our patients are coming from and what their reality is. We need to help our patients overcome health care disparities. In a way, it would be nice to stop writing these papers and talk about how to solve this problem.”
Despite the dire findings, Laurens said she sees reason for optimism. “There is room for a corrective course,” she said. “That is the silver lining.”