Abstract 12635: Mortality Risks and Need For Transplant in Pediatric Heart Disease Associated With Lower Ses and Greater Remoteness of Residence From Cardiac Care

Abstract

Introduction: Socioeconomic status (SES) and remoteness of residence (RoR) may contribute to worse clinical outcomes. Whether this is true in universal healthcare is not certain. We sought to explore associations between SES and RoR, from centralized pediatric cardiac care, and a composite of mortality and need for transplant (Tx) in children with congenital (CHD) and acquired heart disease (AHD). Methods: All infants born in Alberta, Canada between 01/01/05 and 31/12/17, and diagnosed before 31/12/17 were included. CHD was categorized as mild, moderate or severe based on the Bethesda Task Force. AHD included cardiomyopathy, myocarditis, heart failure, rheumatic heart disease and endocarditis. Socioeconomic status (SES) was defined by the Canadian Index of Multiple Depravation’s vulnerability index and RoR was calculated using the drive time to one of two pediatric cardiology centers. Risk factors for a composite of mortality and Tx were explored using Cox proportional hazard regression. Results: Among 12,542 children, 74.5% (n=9347) had mild CHD, 13.8% (n=1733) moderate, 5.7% (n=717), severe and 5.9% (n=745) AHD. The composite outcome was highest in severe CHD (19.0%), compared to 13.0% in moderate, 0.5% for mild and 6.9% in AHD, with n=41 undergoing Tx. Among children with CHD, RoR (>180mins, p=0.018), but not SES, was associated with all-cause mortality/Tx (Table 1), while neither RoR (p=0.73) nor SES (p=0.98) were associated with cardiovascular (CV)-specific mortality/Tx. For AHD there was no association between RoR (p=0.73) and SES (p=0.98) with all-cause mortality/Tx (Table 1). Conclusions: Despite Canada’s universal healthcare, children with CHD who live remotely are at increased risk of all-cause mortality/Tx. This is independent of SES and was not true for children with AHD or CV mortality/Tx in those with CHD. Therefore, further understanding of the causes of death in children who live remotely with CHD may help in improving overall outcomes.