Racial and ethnic disparities in pediatric autoimmune encephalitis: A systematic review

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OBJECTIVES: Health disparities and social determinants of health are increasingly recognized as important predictors for clinical outcomes in autoimmune disease. However, this is poorly studied in pediatric autoimmune encephalitis (AE). METHODS: We conducted a systematic literature review in accordance with PRISMA guidelines. Searches included Medline (Pubmed), EMBASE, and Web of Science databases from inception years to October 4, 2024. Inclusion criteria were: 1) Patients diagnosed with AE ≤ 18 years old; 2) any report of race and/or ethnicity, 3) report of specific diagnostics and disease outcomes, 4) observational cohort studies, epidemiological studies or case series/ cohort studies of n ≥ 5 participants. We excluded studies describing only AE associated with viral encephalitis, case reports or case series with <5 cases, papers without clear racial or ethnicity demographics, no report of clinical outcomes, and non-English studies. Study screening, scoring, and data extraction used the Covidence platform. Study quality utilized the Newcastle-Ottawa scale for case-control and cohort studies, and the Joanna Briggs Institute Critical Appraisal Checklist for epidemiological studies. Descriptive analyses were used to summarize study findings. RESULTS: A total of 35 studies were included in the study: 74 % retrospective cohort, 14 % prospective cohort, 8.6 % epidemiological, and 1 case-control study. Study quality fell mostly into "good" (45.7 %) or "fair" (37 %), and the remaining 17 % were given "poor" quality scores. Among the included studies, 94 % of the studies had pediatric-specific data from which demographic and clinical information could be extracted. Only 12 (34 %) of studies reported outcomes specific to a racial and/or ethnic group - 7 cohort studies from homogenous populations, 3 epidemiological studies, and 2 reported racial frequencies in cognitive outcomes only. No studies compared clinical outcomes among different racial or ethnic groups. DISCUSSION: There is an overall paucity in rigorous studies on health disparities in pediatric AE. Future studies should be aimed at determining individual, social, and structural risk factors that may impact treatment and long-term outcomes.

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