Abstract 12558: Social Determinants of Health and 90-day Readmissions Among Pediatric Patients With Cardiac Disease

Abstract

Introduction: Social determinants of health (SDoH) impact general pediatric readmissions and pediatric cardiac surgical mortality. Yet, little is known of their influence on readmissions in pediatric cardiac disease. Hypothesis: Children with cardiac disease from underrepresented populations, under-resourced neighborhoods or on public insurance are more likely to experience readmission. Methods: This was a multicenter retrospective study of patients <18 years with a cardiac diagnosis and index hospitalization with survival to discharge in the Pediatric Health Information System database (1/1/2017-12/31/2020). The outcome was 90-day all-cause non-elective readmission. SDoH examined were race/ethnicity, insurance type, income, and child opportunity index (COI; a composite variable of residential socioeconomic resources). Mixed effects multivariable logistic regression models were performed. Results: Of 249,222 cardiac-related admissions in 161,039 patients, 90-day readmissions were 55,770 (22.4%). Overall mortality was 2.8% (1.8% in readmissions). Clinical factors associated with readmission were infancy, non-surgical index admission, extracorporeal membrane oxygenation, greater length of stay, and non-cardiac comorbidities. Controlling for these factors, there was greater adjusted odds of 90-day readmission in patients with public or other insurance (vs private), Hispanic or Non-Hispanic Black race/ethnicity (vs Non-Hispanic White) and lower COI area residents (vs higher) [Table]. Sub-analysis in the 38,711 cardiac surgical admissions (15.8% 90-day readmission rate), found similar observations for race and insurance in adjusted analyses. Conclusions: Children with cardiac disease from under-resourced areas, underrepresented populations and/or on public insurance have higher odds of 90-day readmission. Our data provide insights for future interventions to optimize hospital discharge planning in this population.