Abstract 14060: Health Disparities in Exercise Performance in Tetralogy of Fallot

Abstract

Introduction: Patients with tetralogy of Fallot (TOF) from disadvantaged racial and ethnic groups are reported to have worse outcomes, including worse exercise performance. The underlying mechanisms are not fully understood. Hypothesis: We hypothesize that the association of exercise performance with race is mediated by socioeconomic factors. Methods: We conducted a single center retrospective cohort study of TOF patients aged 8 - 30 years who underwent maximal exercise stress testing (EST) from 2007 - 2020. The primary outcome was percent-predicted maximum oxygen consumption (VO2). Addresses were geocoded. The Childhood Opportunity Index (COI) and its three domains represented neighborhood socioeconomic status. Generalized linear models and mediation analysis were used (Figure). Results: We included 154 subjects who underwent 273 ESTs (Table). Correcting for age at EST, sex, outflow tract repair type, and body mass index, those of non-Hispanic Black race had an 8.6% lower percent-predicted VO2 (95% CI -15.0, -2.2) than those of non-Hispanic white race. Mediation analysis showed that the COI mediates 90% of this relationship. By domain, Education is the strongest mediator and alone can account for 75% of this relationship. Conclusions: Disparities exist in exercise performance after TOF repair. Neighborhood-level factors, in particular related to Education, are significant mediators of the relationship between race and exercise performance in TOF. A detailed understanding of the driving mechanisms underlying health disparities, particularly those that are modifiable, is critical to eliminating those disparities at both the patient and societal levels.