Outcome Disparities between Rural and Urban Single Ventricle Infants

Janelle Buysse; Trudy A Pierick; M Bridget Zimmerman; Benjamin Reinking

doi:10.1016/j.jpeds.2025.114602

To evaluate the impact of home location in an urban or rural environment on somatic growth and transplant-free survival in single ventricle infants at one year of age.OBJECTIVETo evaluate the impact of home location in an urban or rural environment on somatic growth and transplant-free survival in single ventricle infants at one year of age.Data were reviewed from 67 centers using the National Pediatric Cardiology - Quality Improvement Collaborative (NPC-QIC) database between 2016-2020. Urban or rural home location was determined using the home zip code's rural urban commuting area (RUCA) code. One-year weight and height z-scores and one-year transplant-free survival were compared between urban and rural groups. Analysis was performed both unadjusted and with adjustments for covariates. Subgroup analysis was performed for race and ethnicity, sex, and insurance type. Multiple imputation was performed to account for missing data in outcomes analysis.STUDY DESIGNData were reviewed from 67 centers using the National Pediatric Cardiology - Quality Improvement Collaborative (NPC-QIC) database between 2016-2020. Urban or rural home location was determined using the home zip code's rural urban commuting area (RUCA) code. One-year weight and height z-scores and one-year transplant-free survival were compared between urban and rural groups. Analysis was performed both unadjusted and with adjustments for covariates. Subgroup analysis was performed for race and ethnicity, sex, and insurance type. Multiple imputation was performed to account for missing data in outcomes analysis.Data from 1403 urban and 351 rural patients were analyzed. Urban infants had higher weight (-0.95 vs -1.16, p<0.01) and height z-scores (-1.65 vs -2.01, p<0.01) at one year of age when compared with rural infants. When adjustments were made for covariates, there was no significant difference (weight p=0.21, height p=0.15). Odds of one-year transplant free survival were lower in urban compared with rural infants (odds ratio for urban vs. rural 0.72, p <0.02).RESULTSData from 1403 urban and 351 rural patients were analyzed. Urban infants had higher weight (-0.95 vs -1.16, p<0.01) and height z-scores (-1.65 vs -2.01, p<0.01) at one year of age when compared with rural infants. When adjustments were made for covariates, there was no significant difference (weight p=0.21, height p=0.15). Odds of one-year transplant free survival were lower in urban compared with rural infants (odds ratio for urban vs. rural 0.72, p <0.02).Rural infants with single ventricle heart disease have higher transplant-free survival to their first birthday. Growth among rural infants may lag behind urban peers, but growth differences are attributable to demographic and disease severity factors.CONCLUSIONRural infants with single ventricle heart disease have higher transplant-free survival to their first birthday. Growth among rural infants may lag behind urban peers, but growth differences are attributable to demographic and disease severity factors.

Outcome Disparities between Rural and Urban Single Ventricle Infants

View Online

Abstract

Details

Metrics