Objective: 

We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU.

Design: 

A retrospective multicenter analysis was conducted using Virtual Pediatric Systems data from reporting centers. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were analyzed using mixed-effects logistic regression modeling to assess for differences in mortality.

Setting: 

One hundred thirty-five PICUs in the United States.

Patients: 

Pediatric patients with cancer admitted to PICUs in the United States.

Interventions: 

None.

Measurements and Main Results: 

This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p < 0.05) compared with Caucasian children (6.3%). Regional analysis showed Hispanic patients to have higher mortality in the West in the United States, whereas African American patients in the South in the United States had higher mortality. A pulmonary disease diagnosis in Hispanics increased odds of mortality (odds ratio, 1.39; 95% CI, 1.13–1.70), whereas a diagnosis of shock/sepsis increased risk for mortality in African Americans (odds ratio, 1.56; 95% CI, 1.11–2.20) compared with Caucasians. There were no differences between races/ethnic groups in the rates of limitations of care. After controlling for Pediatric Risk of Mortality III, PICU length of stay, stem cell transplant status, readmissions, cancer type (solid, brain, hematologic), mechanical ventilation days, and sex, Hispanic (odds ratio, 1.24; 95% CI, 1.05–1.47) and African Americans (odds ratio, 1.37; 95% CI, 1.14–1.66) had significantly higher odds of mortality compared with Caucasians.

Conclusions: 

The results show that after controlling for severity and cancer type, a child’s race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer.

中文翻译：

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在美国，患有癌症的种族/族裔少数民族儿童入读ICU的死亡率更高*

目的： 

我们调查了在PICU入院的患有癌症的各个种族/族裔儿童之间是否存在生存差异。

设计： 

使用来自报告中心的虚拟儿科系统数据进行了回顾性多中心分析。使用混合效应逻辑回归模型分析人口统计学信息，儿童死亡风险评分和结果变量，以评估死亡率差异。

设置： 

美国有一百三十五个PICU。

耐心： 

在美国，小儿癌症患者收治了PICU。

干预措施： 

没有。

测量和主要结果： 

这项研究详细分析了12232例独特的肿瘤患者的23128例PICU入院，占所有PICU入院的3％，死亡1610人（病死率7.0％）。非洲裔美国人（8.5％）和西班牙裔儿童（8.1％）的死亡率明显更高（p<0.05），而白人儿童（6.3％）。区域分析显示，在美国西部，西班牙裔患者的死亡率较高，而在美国南部的非裔美国人患者的死亡率较高。西班牙裔人的肺部疾病诊断增加了死亡率（几率，1.39； 95％CI，1.13-1.70），而电击/败血症的诊断增加了非洲裔美国人的死亡率（几率，1.56； 95％CI，1.11） –2.20）与高加索人相比。种族/族裔群体之间的护理限制率没有差异。在控制了小儿死亡风险III，PICU住院时间，干细胞移植状态，再入院率，癌症之后 类型（实体，脑，血液），机械通气天数和性别，西班牙裔（比值比为1.24； 95％CI，1.05-1.47）和非裔美国人（比值比为1.37； 95％CI，1.14-1.66）与高加索人相比，死亡率更高。

结论： 

结果表明，在控制了严重程度和癌症类型之后，孩子的种族，种族和出诊地区会影响PICU的死亡率。这表明，有必要进行进一步的调查，并有必要重新考虑我们对评估和治疗危重病的非洲裔美国人和西班牙裔儿童癌症的方法。