Race and Household Income are Associated with Disease Outcomes in Pediatric Patients with ANCA‐associated Vasculitis Hospitalized in the United States

OBJECTIVES: Race and household income impact outcomes in patients with rheumatic conditions; however, their role in pediatric anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains poorly understood. We aimed to evaluate whether race/ethnicity and household income are associated with severe AAV disease and renal outcomes among pediatric patients in the United States. METHODS: We used the 2016 and 2019 Kids' Inpatient Database (KID) to identify pediatric AAV hospitalizations. Severe AAV disease was defined by International Classification of Diseases, Tenth Revision (ICD-10) codes indicating organ failure, complications, or the use of life-sustaining procedures. We evaluated associations between race/ethnicity and household income quartile with severe disease, end-stage renal disease (ESRD), and renal transplantation among those with ESRD using univariate and multivariable logistic regression. RESULTS: Among the 673 unweighted AAV hospitalizations, 59% involved at least one severe disease feature. Hispanic race/ethnicity was associated with higher odds of severe disease (adjusted odds ratio [aOR] 1.61, 95% CI 1.01-2.56) and ESRD (aOR 1.98, 95% CI 1.04-3.77). Among patients with ESRD, those in the lowest income quartile had significantly lower odds of renal transplantation compared to those in the highest quartile (aOR 0.18, 95% CI 0.04-0.71). CONCLUSION: In this national sample of hospitalized pediatric patients with AAV, Hispanic race/ethnicity was a statistically significant predictor of severe AAV disease and ESRD, and household income was inversely associated with renal transplantation among those with ESRD. These findings suggest that race and household income may contribute to health inequities in pediatric AAV.