Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 82(9), 801–813. https://doi.org/10.1016/j.jacc.2023.05.069 Dr. Son Q. Duong et al.
Points
- This research examines the links between childhood opportunity, race/ethnicity, and surgical outcomes for pediatric patients with congenital heart disease (CHD).
- The study analyzed a dataset of 54,666 pediatric CHD surgery encounters from 2016 to 2022, linked with the Childhood Opportunity Index (COI) evaluating neighborhood conditions.
- Racial/ethnic disparities were evident, with non-Hispanic Black, Asian, and Other groups showing increased mortality rates compared to non-Hispanic Whites.
- Neighborhood COI partially mediated the impact of race/ethnicity on in-hospital mortality, ranging from 2.6% to 16.8%, depending on model specification.
- Lower COI neighborhoods were associated with poorer neonatal survival rates after hospital discharge, highlighting the potential benefits of targeted investments in such areas to improve outcomes for pediatric CHD patients.
Summary
This research paper investigates the intricate relationships between childhood opportunity, race/ethnicity, and surgical outcomes for pediatric patients with congenital heart disease (CHD). It is well-established that racial and ethnic disparities exist in healthcare outcomes. However, this study offers a more comprehensive understanding by examining how these disparities interact with factors related to childhood opportunity, including education, environment, and socioeconomic conditions. The study encompassed a substantial dataset comprising pediatric encounters under 18 between 2016 and 2022, all diagnosed with CHD and underwent cardiac surgery. These encounters were linked to the Childhood Opportunity Index (COI), which provides a composite score evaluating various aspects of neighborhood conditions, including educational, environmental, and socioeconomic factors.
The research at 47 different healthcare centers included 54,666 pediatric encounters. The findings revealed striking disparities in surgical outcomes based on race and ethnicity. Specifically, non-Hispanic Black (Black), Asian, and Other racial/ethnic groups exhibited statistically significant increases in adjusted mortality rates compared to non-Hispanic Whites. Additionally, children residing in neighborhoods with the lowest COI scores were found to have higher rates of in-hospital mortality in unadjusted models. However, this disparity in mortality diminished when more comprehensive adjustments were made in the statistical models, though it remained noteworthy. Moreover, the research uncovered that COI seemed to partially mediate the effect of race/ethnicity on in-hospital mortality, with mediation percentages ranging between 2.6% and 16.8%, depending on the model specification.
Beyond in-hospital outcomes, the study also investigated neonatal survival rates after hospital discharge. Among the 13,987 pediatric patients included in the analysis with a median follow-up period of 0.70 years, those from neighborhoods with the lowest COI scores exhibited poorer survival rates. This observation underscores the need for further research into the multifaceted relationship between childhood opportunity, race/ethnicity, and surgical outcomes for children with CHD. The study’s findings have significant implications for policymakers and healthcare practitioners aiming to reduce disparities in pediatric healthcare and emphasize the potential benefits of targeted investments in neighborhoods with low COI scores to enhance post-hospital discharge outcomes for these children. Additionally, the research emphasizes the importance of exploring unmeasured factors contributing to the persistent racial/ethnic disparities in healthcare outcomes, as this remains a crucial area for future investigation.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723060370
References Duong, S. Q., Elfituri, M. O., Zaniletti, I., Ressler, R. W., Noelke, C., Gelb, B. D., Pass, R. H., Horowitz, C. R., Seiden, H. S., & Anderson, B. R. (2023). Neighborhood childhood opportunity, race/ethnicity, and surgical outcomes in children with congenital heart disease. Journal of the American College of Cardiology, 82(9), 801–813. https://doi.org/10.1016/j.jacc.2023.05.069
