Long-term Hearing Loss, Anxiety and Neurodevelopmental Outcomes Following Kawasaki Disease: A Population-based Cohort Study

Cal Robinson¹, Francis Lao², Rahul Chanchlani¹, Anastasia Gayowsky³, Sandeep Brar⁴, Elizabeth Darling⁵, Catherine Demers⁵, Tapas Mondal¹, Rulan Parekh⁶, Hsien Seow⁵ and Michelle Batthish¹, ¹McMaster Children's Hospital, Hamilton, ON, Canada, ²Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada, ³ICES McMaster, Hamilton, ON, Canada, ⁴University of California, San Fransisco, ⁵McMaster University, Hamilton, ON, Canada, ⁶University of Toronto, Toronto, Canada

Meeting: ACR Convergence 2020

Keywords: Anxiety, Cognitive dysfunction, Disability, Pediatric rheumatology, Vasculitis

Session Information

Date: Monday, November 9, 2020

Title: Pediatric Rheumatology – Clinical Poster III: SLE, Vasculitis, & JDM

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: The incidence of Kawasaki disease (KD) is increasing in Ontario. Cardiovascular sequelae following KD are well-described. However, there are limited and conflicting non-cardiovascular outcome data among KD survivors. Our objectives were to determine the incidence and risk of hearing loss, anxiety, developmental disorders, intellectual disabilities and attention-deficit/hyperactivity disorder (ADHD) among KD survivors vs. non-exposed children.

Methods: We included all Ontario children (≤18yr) surviving hospitalization with a KD diagnosis between 1995-2018, through validated algorithms using population-based health administrative databases. We excluded children with a prior KD diagnosis, non-residents, and those with incomplete records. KD cases were matched with 100 non-exposed children by age, sex and index admission year. Follow-up continued until death or March 2019. We calculated the prevalence, incidence (per 1000 person-years (py)) and unadjusted hazard ratios (HR) for each outcome between 0-1yr, 1-5yr, 5-10yr and >10yr.

Results: Among 4,597 KD survivors and 459,700 non-exposed children (median 11.1yr follow-up), KD survivors had more hearing loss: 364 cases (7.9%) vs. 31,442 (6.8%); anxiety disorders: 1,213 (26.4%) vs. 99,965 (21.8%); developmental disorders: 398 (8.7%) vs. 28,211 (6.1%); intellectual disabilities: 52 (1.1%) vs. 2,931 (0.6%); and ADHD: 21 (0.5%) vs. 1,214 (0.3%). Compared to non-exposed children, KD survivors were at increased risk of hearing loss between 0-1yr (HR 1.25 [95%CI 1.00-1.54]); anxiety disorders between 0-1yr (HR 1.75 [1.46-2.10]), 1-5yr (HR 1.12 [1.00-1.27]) and 5-10yr (HR 1.12 [1.00-1.25]); developmental disorders between 0-1yr (HR 1.66 [1.42-1.93]) and 1-5yr (HR 1.24 [1.06-1.46]); intellectual disabilities between 1-5yr (HR 1.64 [1.07-2.53]) and >10yr (HR 2.55 [1.47-4.43]); and ADHD >10yr after index hospitalization (HR 1.97 [1.11-3.48]).

Conclusion: KD survivors are at increased risks of adverse neurodevelopmental outcomes, which may impair their academic and social functioning. This justifies enhanced developmental and audiological surveillance of KD survivors.

Table 1. Incidence and risk of hearing loss, anxiety and neurodevelopmental disorders, comparing KD vs. non-exposed children at 0-1yr, 1-5yr, 5-10yr and >10yr follow-up

Figure 1. Anxiety disorder-free survival among KD survivors vs. non-exposed children

Disclosure: C. Robinson, None; F. Lao, None; R. Chanchlani, None; A. Gayowsky, None; S. Brar, None; E. Darling, None; C. Demers, None; T. Mondal, None; R. Parekh, None; H. Seow, None; M. Batthish, Abbvie, 2.

To cite this abstract in AMA style:

Robinson C, Lao F, Chanchlani R, Gayowsky A, Brar S, Darling E, Demers C, Mondal T, Parekh R, Seow H, Batthish M. Long-term Hearing Loss, Anxiety and Neurodevelopmental Outcomes Following Kawasaki Disease: A Population-based Cohort Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/long-term-hearing-loss-anxiety-and-neurodevelopmental-outcomes-following-kawasaki-disease-a-population-based-cohort-study/. Accessed .

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