257: GEOGRAPHY AND AGE DRIVE RACIAL AND ETHNIC DISPARITIES IN PEDIATRIC PNEUMONIA MORTALITY

Abstract

Introduction: Racial disparities in adult community acquired pneumonia (CAP) outcomes are described. Disparities in pediatric CAP and potential mechanisms underlying disparities remain unclear. Literature shows that demographics including race, socioeconomic status, education level, and geographic region intersect in their associations with health outcomes. Given disparities in outcomes related to age and geography in sepsis, a related diagnosis, we aimed to determine whether age and geography modified the association between race and mortality in CAP. We hypothesized that Black and Hispanic patients would have higher mortality and that geographic region and age would clarify potential contributing mechanisms. Methods: This is a retrospective cohort study of children age < 18 years with a diagnosis of CAP admitted between 2016 and 2021 in the Public Health Information System (n=44 children’s hospitals). We investigated the intersection of race, age, and regional effects by creating a joint exposure variable incorporating 4 racial/ethnic groups (White, Black, Hispanic, and Other), 2 age categories (≤1 and >1 year), and 4 geographic regions (Northeast, South, Midwest, West) into 1 categorical exposure. We performed mixed-effect multivariable logistic regression, clustering by the hospital as a random effect. We used the joint exposure variable to quantify the relationship between race, age, and geographic region with mortality for CAP. Joint exposure modeling shows the combined effect of multiple exposures as a single variable with an outcome. Mixed effect analyses adjusted for rurality, income, sex, insurance type, and complex chronic conditions. Results: Among 783,744 patients (median age 4 years, IQR 1-9; 46% female) with CAP, the overall mortality rate was 0.9%. Joint analysis revealed region and age ≤1 year conferring increased mortality risk. Black patients ≤1 year in the South (aOR 2.35, 95% CI 1.52-3.63, p< 0.001) and West (aOR 2.47, 95% CI 1.35-4.49, p=0.003) and Hispanic patients ≤1 year in the Northeast (aOR 2.36, 95% CI 1.46-3.66, p = 0.031) had the highest adjusted mortality odds. Conclusions: We found evidence of racial disparities in mortality for children diagnosed with CAP. Joint associations of age and geographic region may partially explain mechanisms underlying these racial disparities.