Pediatric Cushing Disease: Disparities in Disease Severity and Outcomes in the Hispanic and African American Populations

BACKGROUND: Little is known about the contribution of racial and socioeconomic disparities to severity and outcomes for children with Cushing disease (CD). METHODS: 129 children with CD, 45 Hispanic/Latino or African American (HI/AA) and 84 non-Hispanic White (non-HW), are included. A 10-point index for rating severity (CD-severity) incorporated degree of hypercortisolemia, glucose tolerance, hypertension, anthropomorphic measurements, disease duration, and tumor characteristics. Race, ethnicity, age, gender, local obesity prevalence, estimated median income, and access to care were assessed in regression analyses of CD-severity. RESULTS: The mean CD-severity for the HI/AA group was worse than the non-HW group (4.9 ± 2.0 vs 4.1 ± 1.9, p = 0.023); driving factors included higher cortisol levels and larger tumor size. Multiple regression models confirmed that race (p=0.027) and older age (p=0.014) were the most important predictors of worse CD-severity. When followed up a median of 2.3 years after surgery, the relative risk of persistent CD combined with recurrence was 2.8 times higher in HI/AA compared to non-HW (95% CI: 1.2–6.5). CONCLUSIONS: Our data show that the driving forces for the discrepancy in severity of CD are older age and race/ethnicity. Importantly, risk of persistent and recurrent CD was higher in minority children.