Socioeconomic Mediators of Racial and Ethnic Disparities in Congenital Heart Disease Outcomes: A Population‐Based Study in California

Journal of the American Heart Association - Tập 7 Số 20 - 2018
Shabnam Peyvandi1, Rebecca J. Baer2,3, Anita J. Moon‐Grady1, Scott P. Oltman2, Christina Chambers3, Mary E. Norton4, Satish Rajagopal1, Kelli K. Ryckman5, Laura L. Jelliffe‐Pawlowski2, Martina A. Steurer2,1
1Divisions of Cardiology and Critical Care, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA
2Department of Epidemiology & Biostatistics and the California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
3Department of Pediatrics, University of California San Diego, La Jolla, California
4Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco Benioff Children's Hospital, San Francisco, CA
5Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa

Tóm tắt

Background Racial/ethnic and socioeconomic disparities exist in outcomes for children with congenital heart disease. We sought to determine the influence of race/ethnicity and mediating socioeconomic factors on 1‐year outcomes for live‐born infants with hypoplastic left heart syndrome and dextro‐Transposition of the great arteries. Methods and Results The authors performed a population‐based cohort study using the California Office of Statewide Health Planning and Development database. Live‐born infants without chromosomal anomalies were included. The outcome was a composite measure of mortality or unexpected hospital readmissions within the first year of life defined as >3 (hypoplastic left heart syndrome) or >1 readmissions (dextro‐Transposition of the great arteries). Hispanic ethnicity was compared with non‐Hispanic white ethnicity. Mediation analyses determined the percent contribution to outcome for each mediator on the pathway between race/ethnicity and outcome. A total of 1796 patients comprised the cohort (n=964 [hypoplastic left heart syndrome], n=832 [dextro‐Transposition of the great arteries]) and 1315 were included in the analysis (n=477 non‐Hispanic white, n=838 Hispanic). Hispanic ethnicity was associated with a poor outcome (crude odds ratio, 1.72; 95% confidence interval [CI], 1.37–2.17). Higher maternal education (crude odds ratio 0.5; 95% CI , 0.38–0.65) and private insurance (crude odds ratio, 0.65; 95% CI , 0.45–0.71) were protective. In the mediation analysis, maternal education and insurance status explained 33.2% (95% CI , 7–66.4) and 27.6% (95% CI , 6.5–63.1) of the relationship between race/ethnicity and poor outcome, while infant characteristics played a minimal role. Conclusions Socioeconomic factors explain a significant portion of the association between Hispanic ethnicity and poor outcome in neonates with critical congenital heart disease. These findings identify vulnerable populations that would benefit from resources to lessen health disparities.

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Journal of the American Heart Association

Tập 7 Số 20

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