Abstract 14250: Interpretation of Pediatric Cardiopulmonary Exercise Testing: Impact of Socioeconomic Status

Abstract

Introduction: Peak oxygen consumption (pVO 2 ) is a marker of cardiovascular fitness. While anthropometric data are incorporated into predictive equations, like the Cooper equation, social determinants of health are not. We hypothesized that socioeconomic status (SES) has a greater effect than standard demographic values on predicted pVO 2 in a contemporary population. Methods: This is a retrospective analysis of maximal cardiopulmonary exercise test (CPET) data from 2010 to 2020 for largely healthy patients age <19 years with BMI percentile (BMI%) between 5-95. Data were sorted by self-identified race, BMI%, and adjusted gross income (AGI) based on IRS zip code data; AGI was used as a surrogate for SES. Mean percent predicted pVO 2 (%ppVO 2 ) was compared between groups for each variable. Linear regression was used to adjust for differences. Results: A total of 541 CPETs met inclusion criteria. Mean %ppVO 2 was 97% ± 22.6 predicted (p<0.001) with 30% below criterion standard for normal (85% predicted). After excluding unknown AGI and race, 418 CPETs remained. Mean %ppVO 2 was lower for blacks (n=36) and LatinX (n=26) compared to whites (n=333, p=0.007). Mean %ppVO 2 significantly declined as AGI decreased (p<0.001). The differences in %ppVO 2 between racial categories compared to white remained significant when adjusted for BMI% (black r=-7.3, p=0.035; LatinX r=-15.4, p=0.001). However, these differences both decreased in magnitude and were no longer significant when adjusted for AGI (black r=-6.0, p=0.150; LatinX r=-9.3, p=0.055). Conclusions: Lower SES correlates negatively with measured cardiovascular fitness and may confound data interpretation. When using normative reference ranges in clinical decision making, providers should recognize that social determinants of health, rather than patient-related factors, may be more related to predicted fitness. Attention should be paid to social inequities when assessing pediatric cardiovascular fitness.