Inpatient outcomes among children with Down syndrome: a Kids’ Inpatient Database study

• Published in: BMC pediatrics Vol. 25; no. 1; pp. 602 - 12
• Main Authors: Tsou, Po-Yang, Wang, Yu-Hsun, Tapia, Ignacio E.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.08.2025; BioMed Central; BMC
• Subjects: Adolescent; Asthma; Black; Black or African American - statistics & numerical data; Cardiovascular disease; Child; Child, Preschool; Children; Codes; Congenital diseases; Databases, Factual; Down syndrome; Down Syndrome - ethnology; Down Syndrome - mortality; Down Syndrome - therapy; Family income; Female; Gastroesophageal reflux; Health care; Heart; Hospital Mortality; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Households; Humans; Hypothyroidism; Inequality; Infant; Infant, Newborn; Intubation; Length of Stay - statistics & numerical data; Leukemia; Male; Mortality; Patient outcomes; Pediatric research; Pediatrics; Physiological aspects; Pneumonia; Pulmonary hypertension; Race; Racial differences; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Software; Statistical analysis; United States - epidemiology; Variables; White; United States; United States > US; Black; Children; Down syndrome
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-025-05899-9

Children with Down Syndrome (DS) are more likely to have multi-system comorbidities leading to more frequent hospitalizations than the general population. We aim to evaluate whether racial differences contribute to hospitalization outcomes and mortality among children with DS. Hospital discharge records were obtained for children (< 21 y) with DS hospitalized between 2006 and 2019 from the Kid's Inpatient Database. The primary exposure was the Black race. Primary outcomes were invasive mechanical ventilation (IMV) and mortality. Secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable logistic regression models were used to ascertain associations between Black race and outcomes. Among 163,870 hospitalizations in children with DS, 16,208 (9.89%) were Black children. Compared with non-Black children, Black children were younger, of lower household incomes, more likely to have public insurance, more likely to have asthma, OSA, obesity, prematurity, congenital heart disease, pulmonary hypertension, congenital airway anomalies, neuromuscular weakness, and dysphagia. Descriptive analyses indicated that Black race was associated with higher risks of mortality, IMV, NIMV, longer LOS, and greater IACH. After multivariable adjustment, Black race remained independently associated with mortality (OR:1.35, 95%-CI:1.15-1.59, p < 0.0001), IMV (OR:1.34, 95%-CI:1.23-1.45, p < 0.0001), NIMV (OR:1.41, 95%-CI:1.26-1.59, p < 0.0001) and increased LOS (IRR:1.08, 95%-CI:1.04-1.13, p < 0.0001), but not IACH. Hospitalized Black children with DS are more likely to be younger, of lower household incomes, with public insurance, and with other underlying comorbidities. Black children had increased risks of mortality and IMV and increased LOS.