Background <p>Pediatric long COVID and other post-COVID conditions, particularly in relation to racial, ethnic, and household social determinants, are not yet well understood. This study aims to synthesize evidence on racial and ethnic disparities in pediatric long COVID and related conditions like MIS-C.</p> Methods <p>A systematic review and meta-analysis were performed on studies reporting post-COVID conditions and outcomes by race and ethnicity. Studies were identified through comprehensive database searches, screened for relevance, and assessed for quality. Data on race, ethnicity, and social determinants were extracted and analyzed using random-effects models to estimate pooled odds ratios. Sensitivity analyses were performed to address potential publication bias.</p> Results <p>Non-Hispanic Black children had significantly higher odds of ICU admission (OR 1.89, 95% CI 1.01–3.28), MIS-C development (OR 2.37, 95% CI 1.43–3.90), and PIMS-TS (OR 16.28, 95% CI 9.24–28.70) compared to Non-Hispanic White children. Although Hispanic children showed a protective effect against severe MIS-C (OR 0.77, 95% CI 0.64–0.93), their MIS-C incidence remained higher (OR 2.70, 95% CI 1.10–6.65). Elevated risks of MIS-C death were observed for Asian/Pacific Islander (OR 6.79, 95% CI 1.2-38.52) and Alaskan Indian/Native American children (OR 4.07, 95% CI 3.4-44.53). Additionally, Asian children had increased odds of PIMS-TS (OR 6.42, 95% CI 2.70-15.27), while groups labeled as ‘Other’ were at higher odds for both PIMS-TS (OR 9.75, 95% CI 3.04–31.30) and MIS-C (OR 2.36, 95% CI 1.18–4.71).</p> Conclusions <p>Significant racial and ethnic disparities in pediatric long COVID, and MIS-C outcomes emphasize the need for targeted interventions addressing social and healthcare inequities.</p> Clinical trial number <p>Not applicable.</p>