# Geographical and racial and/or ethnic disparities in pediatric ARDS mortality in the USA, 2016–2022: a triennial national database retrospective cohort analysis

## TL;DR

This study finds that mortality from pediatric ARDS in the US varies by region and race/ethnicity, with Black and other minority children facing higher risks compared to White children in the Northeast.

## Contribution

The study identifies persistent geographical and racial/ethnic disparities in pediatric ARDS mortality using national data from 2016 to 2022.

## Key findings

- Algorithm-defined ARDS affected about 42,000 hospitalizations annually, with increasing prevalence from 2016 to 2022.
- Black children in the South and West had significantly higher predicted mortality rates compared to White children in the Northeast.
- Mortality disparities remained stable from 2016 to 2019 but increased from 2019 to 2022.

## Abstract

Disparities in pediatric critical care outcomes are recognized, but national data describing Pediatric Acute Respiratory Distress Syndrome (PARDS) prevalence, mortality and temporal trends are limited. We described prevalence, and regional and racial/ethnic mortality disparities for algorithm-defined ARDS, a surrogate for PARDS in US children from 2016 to 2022.

We performed a retrospective cohort study using the 2016, 2019, and 2022 Kids' Inpatient Database (KID). Algorithm-defined ARDS was identified with an ICD-10 approach requiring acute respiratory failure from pulmonary, sepsis, or shock etiologies requiring invasive mechanical ventilation ≥24 h. The primary outcome was in-hospital mortality. Exposures were US region and Race/Ethnicity, modeled individually and jointly. Mixed-effect logistic regression models, adjusting for income quartile, APR-DRG severity of illness, hospital type, and complex chronic conditions, estimated adjusted mortalities and risk differences.

Algorithm-defined ARDS occurred in about 42,000 hospitalizations per year, with prevalence increasing from 0.68% (95% CI 0.67–0.69) in 2016 to 0.75% (0.74–0.75) in 2022. Overall mortality was 12.9% (12.5–13.3) in 2016, 12.5% (12.1–12.9) in 2019, and 13.7% (13.3–14.1) in 2022. In the joint model, relative to Northeastern White children (predicted 10.9%, 95% CI 9.72–12.1), risks were higher for Black children in the South (predicted 14.2%, ARD 3.27%, 1.74–4.79) and West (14.6%, ARD 3.69%, 1.39–6.00); Hispanic children in the West (12.6%, ARD 1.70%, 0.09–3.31), and children of Other race/ethnicity in the South (16.5%, ARD 5.57%, 3.14–7.99) and West (14.0%, ARD 3.11%, 0.96–5.25). Disparities did not meaningfully change from 2016 to 2019, while mortality increased from 2019 to 2022.

Algorithm-defined ARDS among hospitalized US children remains common and highly fatal. Persistent regional and racial/ethnic disparities highlight systemic drivers of inequity and the need for targeted interventions.

This work was supported by the 10.13039/100000050National Heart, Lung, and Blood Institute, National Institutes of Health (Award K23HL177271, PI: Keim).