“The best preparation for tomorrow is to do today’s work superbly well” –William Osler (quote cited in NEJM 2014; 371: 1565-66).
The quote above is not directly related to today’s post but I liked it a lot.
While race “encompasses social, economic, and cultural issues,” it is a marker for health outcomes including in children with intestinal failure (JPGN 2014; 59: 537-43). This Pediatric Intestinal Failure Consortium study retrospectively analyzed 272 subjects, though 22 did not have adequate data regarding race. In this cohort, there were 204 white and 46 nonwhite children.
- Nonwhite children were more likely to die without an intestinal transplant (P<0.001). At 48 months after entry criteria were met, cumulative probability of death without an intestinal transplant was 0.40 for nonwhite children compared with 0.16 for white children.
- Nonwhite children were less likely to receive an intestinal transplant (P=0.003). At 48 months after entry criteria were met, cumulative probability of receiving an intestinal transplant was 0.07 for nonwhite children compared with 0.31 for white children.
These findings held up when examined for biological factors like low birth rate and reason for intestinal transplantation; other factors that were accounted for included evidence of liver disease, residual bowel length, and whether child had received care at an intestinal transplantation center. Even factors like receiving breast milk in the nursery were similar between the two groups.
Bottomline: Nonwhite race appears to be a marker for poor outcomes in children with intestinal failure. Based on this retrospective data which examined multiple factors, the reasons do not have a biological basis. As such, issues like barriers to treatment/access to care, social support, parental education, and cultural differences need to be considered.