Racial and Ethnic Composition of Populations Served by Free-Standing Children's Hospitals and Disparities in Outcomes of Pediatric Lupus.

OBJECTIVE: Health disparities may be driven by hospital-level factors. We assessed whether racial and ethnic composition of populations hospitals serve explain or modify disparities in hospital outcomes of children with systemic lupus erythematosus (SLE).

METHODS: In this retrospective cohort study of patients 5-26 years old with SLE at 47 children's hospitals in the Pediatric Health Information System (2006-2021), race and ethnicity were assessed at the patient-level and hospital-level (proportion of total admissions comprised by Black or Hispanic patients, respectively). Outcomes included intensive care unit (ICU) admission or adverse renal outcome (end-stage renal disease, dialysis or transplant) during follow-up. We estimated racial-ethnic disparities, adjusted or stratified by hospital racial or ethnic composition.

RESULTS: Of 8125 patients with SLE, 2293 (28%) required ICU admission and 698 (9%) had an adverse renal outcome. Black/non-Hispanic White disparities in ICU admission were observed only at hospitals serving higher proportions of Black patients (OR 1.29, 95% CI [1.04-1.59] vs. 1.07, [0.83-1.38]). Larger Black/non-Hispanic White disparities in adverse renal outcomes were observed at hospitals with higher Black racial composition (OR 2.0, [1.4-2.8] vs. 1.7, [1.1-2.4]). Conversely, Hispanic vs. non-Hispanic disparities in renal outcomes persisted after adjustment for hospital-reported Hispanic ethnic composition but were observed only at hospitals with lower proportions of Hispanic patients.

CONCLUSION: Worse Black/White disparities in SLE outcomes are observed at children's hospitals serving more Black children, whereas distinct patterns are observed for Hispanic/non-Hispanic disparities. Reporting of hospital characteristics related to populations served is needed to identify modifiable drivers of hospital-level variation.