Abstract 11922: The Independent Effects of Race/Ethnicity and Local Childhood Opportunity on Outcomes in Pediatric Congenital Heart Surgery

Abstract

Background: Disparities in congenital heart disease (CHD) outcomes based on race/ethnicity and social determinants of health coexist. We sought to determine the independent effects of these factors on outcomes after pediatric CHD surgery. Methods: Pediatric Health Information System encounters age <18 years from 2003-2022 with ICD9/10 codes for CHD and cardiac surgery were linked to Zip Code-level Childhood Opportunity Index (COI), a score of neighborhood educational, environmental, and socioeconomic conditions. Independent effects of race/ethnicity and COI quintile on the outcome of death during surgical hospitalization were modeled with generalized estimating equations. Survival in neonates was modeled with Cox PH regression. Results: Of 193,028 encounters at 46 centers, Black, Asian, and Other groups had increased adjusted mortality compared to Non-Hispanic (NH) White. Compared to the middle COI quintile, the lowest quintile had a higher adjusted risk of death and the highest quintile was protective (Table 1a). In survival analysis of neonates (n=47,649; median follow-up 1.1 years), Black, Asian, and “Other” groups had worse survival than NH-White even after adjustment for COI quintile (Table 1b, Figure 1). Conclusions: Black, Asian, and “Other” children have increased in-hospital death after CHD surgery independent of local opportunity. Medium-term survival after neonatal surgery is similarly influenced, suggesting local opportunity is influential even at birth. Policies to improve local social determinants of health may improve outcomes, but persistent negative effects of minority status may be explained by other unmeasured forms of structural racism.