In the Journals

Socioeconomic factors confer poor outcomes for Hispanic infants with congenital heart disease

The association between Hispanic ethnicity and poor outcomes in neonatal children with critical congenital heart disease may be primarily explained through socioeconomic factors, according to a study published in the Journal of the American Heart Association.

“This study demonstrates the socioeconomic factors that can in part explain the disparities seen between Hispanic infants with congenital heart disease compared to white infants,” Shabnam Peyvandi, MD, assistant professor in the division of pediatric cardiology at University of California, San Francisco, said in a press release. “Maternal education levels likely act as a proxy for other socioeconomic factors that may impede access to care and available resources to certain communities. Community engagement and outreach to at-risk communities are initial steps in identifying specific barriers to health care access with a goal of improving outcomes for all children with congenital heart disease.”

Researchers analyzed data from 1,796 infants from California’s Office of Statewide Health Planning and Development database with a gestational age between 22 and 42 weeks who had hypoplastic left heart syndrome (n = 964) or d-transposition of the great arteries (n = 832). Information from this database included infant and maternal clinical and demographic characteristics from hospital discharge records. Other factors assessed were race/ethnicity, socioeconomic factors, education, community dwelling and insurance status.

The primary outcome for infants with hypoplastic left heart syndrome was death or more than three readmissions within the first year of life. For infants with d-transposition of the great arteries, the primary outcome was death or more than one readmission within the first year of life.

Because other racial and ethnic groups such as non-Hispanic black and Asian infants were less well-represented in the database, the analysis only included infants who were Hispanic (n = 838) or non-Hispanic white (n = 477), the researchers wrote.

Hispanic infants were more likely to have a poor outcome compared with non-Hispanic white infants (crude OR = 1.72; 95% CI, 1.37-2.17). Those who were less likely to have poor outcomes included infants born to mothers with an education greater than 12 years (crude OR = 0.5; 95% CI, 0.38-0.65) and with private insurance (crude OR = 0.65; 95% CI, 0.45-0.71).

Insurance status accounted for 27.6% of the link between Hispanic ethnicity and outcome (95% CI, 6.5-63.1), whereas maternal education explained 33.2% of the relationship (95% CI, 7-66.4), according to the researchers. Mediators that were not significant in the relationship between Hispanic ethnicity and outcome were birth weight (1.5%; 95% CI, –2.5 to 5.7) and maternal age (1.9%; 95% CI, –0.8 to 6.2).

“Providing additional resources to these vulnerable populations has the potential to improve both short- and long-term outcomes, in addition to being cost-effective (ie, decreasing the number [of] total hospital admissions),” Peyvandi and colleagues wrote. “Further work is being performed to assess cost-effectiveness and to incorporate other measures of socioeconomic status.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

The association between Hispanic ethnicity and poor outcomes in neonatal children with critical congenital heart disease may be primarily explained through socioeconomic factors, according to a study published in the Journal of the American Heart Association.

“This study demonstrates the socioeconomic factors that can in part explain the disparities seen between Hispanic infants with congenital heart disease compared to white infants,” Shabnam Peyvandi, MD, assistant professor in the division of pediatric cardiology at University of California, San Francisco, said in a press release. “Maternal education levels likely act as a proxy for other socioeconomic factors that may impede access to care and available resources to certain communities. Community engagement and outreach to at-risk communities are initial steps in identifying specific barriers to health care access with a goal of improving outcomes for all children with congenital heart disease.”

Researchers analyzed data from 1,796 infants from California’s Office of Statewide Health Planning and Development database with a gestational age between 22 and 42 weeks who had hypoplastic left heart syndrome (n = 964) or d-transposition of the great arteries (n = 832). Information from this database included infant and maternal clinical and demographic characteristics from hospital discharge records. Other factors assessed were race/ethnicity, socioeconomic factors, education, community dwelling and insurance status.

The primary outcome for infants with hypoplastic left heart syndrome was death or more than three readmissions within the first year of life. For infants with d-transposition of the great arteries, the primary outcome was death or more than one readmission within the first year of life.

Because other racial and ethnic groups such as non-Hispanic black and Asian infants were less well-represented in the database, the analysis only included infants who were Hispanic (n = 838) or non-Hispanic white (n = 477), the researchers wrote.

Hispanic infants were more likely to have a poor outcome compared with non-Hispanic white infants (crude OR = 1.72; 95% CI, 1.37-2.17). Those who were less likely to have poor outcomes included infants born to mothers with an education greater than 12 years (crude OR = 0.5; 95% CI, 0.38-0.65) and with private insurance (crude OR = 0.65; 95% CI, 0.45-0.71).

Insurance status accounted for 27.6% of the link between Hispanic ethnicity and outcome (95% CI, 6.5-63.1), whereas maternal education explained 33.2% of the relationship (95% CI, 7-66.4), according to the researchers. Mediators that were not significant in the relationship between Hispanic ethnicity and outcome were birth weight (1.5%; 95% CI, –2.5 to 5.7) and maternal age (1.9%; 95% CI, –0.8 to 6.2).

“Providing additional resources to these vulnerable populations has the potential to improve both short- and long-term outcomes, in addition to being cost-effective (ie, decreasing the number [of] total hospital admissions),” Peyvandi and colleagues wrote. “Further work is being performed to assess cost-effectiveness and to incorporate other measures of socioeconomic status.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.