Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2.

Importance: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. Objective: To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. Design, Setting, and Participants: This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1 000 000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. Exposures: Race/ethnicity, sex, and age group (ie, ≤5, 6-10, 11-15, and 16-20 years). Main Outcomes and Measures: Overall and stratum-specific adjusted estimated MIS-C incidence per 1 000 000 person-months and per 1 000 000 SARS-CoV-2 infections. Results: In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1 000 000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1 000 000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1 000 000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1 000 000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1 000 000 person-months). Conclusions and Relevance: In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group.

Prevalence and Predictors of Per- and Polyfluoroalkyl Substances (PFAS) Serum Levels among Members of a Suburban US Volunteer Fire Department.

BACKGROUND: Per-and polyfluoroalkyl substances (PFAS), are ubiquitous pollutants associated with adverse health outcomes. High PFAS levels have been demonstrated among career firefighters; less is known about PFAS levels among volunteer firefighters who comprise two-thirds of US firefighters. METHODS: Volunteer fire department members completed a survey and provided blood samples. We calculated geometric means and 95% CIs for PFAS reported by the National Health and Nutrition Examination Survey (NHANES). We compared PFAS distribution and levels among non-Hispanic white adult male study participants to those in the 2015-2016 and 2017-2018 NHANES cycles. We assessed associations between PFAS serum levels and years of firefighting controlling demographics and occupation using linear regression. RESULTS: Participant's average age was 46.6 years (sd. 17.1). Perfluorododecanoic acid (PFDoA) was detected in almost half study but <3% of NHANES participants; serum levels of PFDoA, perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were elevated among participants compared with NHANES. Serum levels of both PFDA and PFDoA were positively associated with years of firefighting. CONCLUSIONS: Volunteer firefighters may have a different serum profile and levels of PFAS than the general population. Future work in this area should include volunteer firefighters from other geographic locations and assess sources of PFAS exposure.

Gender Disparities in Income Among Board-Certified Dermatologists.

Although there is evidence that gender-based disparities exist in salary, academic rank, and other factors in several areas in medicine, limited data exist on differences between male and female dermatologists. Existing studies have focused on academic dermatologists, not including the vast majority of dermatologists who work in solo and group private practices. A cross-sectional self-reported survey eliciting total annual income and other factors was performed in the fall of 2018 in the United States. A total of 397 board-certified dermatologists (MDs/DOs) participated in this study, including 53.63% female and 46.37% male respondents. A statistically significant difference existed within total annual income between male and female dermatologists (P<.0001). Several factors were identified that demonstrated statistically significant differences between male and female dermatologists, including productivity, practice area of focus, type of fellowship training, and faculty rank. However, despite controlling for these variations, gender remained a statistically significant predictor of income on both univariate and multivariate regression analyses (P=.0002/P<.0001), indicating that a gender-based income disparity exists in the field of dermatology that cannot be explained by other factors.