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

Shabnam Peyvandi; Rebecca J Baer; Anita J Moon-Grady; Scott P Oltman; Christina D Chambers; Mary E Norton; Satish Rajagopal; Kelli K Ryckman; Laura L Jelliffe-Pawlowski; Martina A Steurer

doi:10.1161/JAHA.118.010342

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

Journal article

Open access

Peer reviewed

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

Shabnam Peyvandi, Rebecca J Baer, Anita J Moon-Grady, Scott P Oltman, Christina D Chambers, Mary E Norton, Satish Rajagopal, Kelli K Ryckman, Laura L Jelliffe-Pawlowski and Martina A Steurer

Journal of the American Heart Association, Vol.7(20), pp.e010342-e010342

10/16/2018

DOI: 10.1161/JAHA.118.010342

PMCID: PMC6474947

PMID: 30371284

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Abstract

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.

Healthcare Disparities - statistics & numerical data

Health Status Disparities

California - epidemiology

Humans

Hospitalization - statistics & numerical data

Hispanic Americans - statistics & numerical data

Infant

Male

Educational Status

Mothers - statistics & numerical data

Gestational Age

Socioeconomic Factors

Insurance, Health - statistics & numerical data

Female

Heart Defects, Congenital - mortality

California - ethnology

Infant, Newborn

Cohort Studies

Heart Defects, Congenital - ethnology

Details

Title: Subtitle: Socioeconomic Mediators of Racial and Ethnic Disparities in Congenital Heart Disease Outcomes: A Population-Based Study in California
Creators: Shabnam Peyvandi - 1 Divisions of Cardiology and Critical Care Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA
Rebecca J Baer - 4 Department of Pediatrics University of California San Diego La Jolla California
Anita J Moon-Grady - 1 Divisions of Cardiology and Critical Care Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA
Scott P Oltman - 2 Department of Epidemiology & Biostatistics and the California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
Christina D Chambers - 4 Department of Pediatrics University of California San Diego La Jolla California
Mary E Norton - 3 Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco Benioff Children's Hospital San Francisco CA
Satish Rajagopal - 1 Divisions of Cardiology and Critical Care Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA
Kelli K Ryckman - 5 Department of Epidemiology College of Public Health, University of Iowa Iowa City Iowa
Laura L Jelliffe-Pawlowski - 2 Department of Epidemiology & Biostatistics and the California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
Martina A Steurer - 2 Department of Epidemiology & Biostatistics and the California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.7(20), pp.e010342-e010342
Publisher: England
DOI: 10.1161/JAHA.118.010342
PMID: 30371284
PMCID: PMC6474947
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: K23 NS099422 / NINDS NIH HHS
Language: English
Date published: 10/16/2018
Academic Unit: Stead Family Department of Pediatrics; Epidemiology
Record Identifier: 9983995170702771

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