Abstract P233: Child Opportunity Index And Prevalence Of Obesity And Hypertension In Adolescents With Congenital Heart Disease

Abstract

Introduction: The Child Opportunity Index (COI) is a measure of neighborhood conditions encompassing educational, health, environmental, social, and economic components that affect child development. Worse COI has been associated with increased cardiometabolic risk in children. Hypertension (HTN) and obesity leads to left ventricular hypertrophy (LVH) and are risk factors for cardiac events in adulthood. However, the impact of COI on patients with congenital heart disease (CHD) has not been well described. Hypothesis: We hypothesized that CHD youths with lower COI would have higher rates of obesity and hypertension compared to higher COI patients. Methods: We retrospectively reviewed adolescent CHD patients with an echocardiogram between 2012-2019. Patients aged 13-17 years with blood pressure (BP), height, weight, and echo measurement for LVMi-HT 2.7 were included. Home location was geocoded and linked to public COI data. Patients were classified by COI into Very Low (VL), Low (L), Moderate (M), High (H), and Very High (VH) opportunity levels. Obesity was defined as body mass index (BMI) ≥ 95 th percentile. Blood pressure was defined as normotensive (NT, SBP < 120 mm Hg), elevated BP (E-BP, 120 ≤ SBP < 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP < 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Left ventricular hypertrophy (LVH) was defined as LVMi-HT 2.7 ≥ 38.6 g/ht 2.7 . Results: A total of 801 patients (mean age 15.5 ± 1.5 years, 57.43% male [460/801]) were included in this analysis. COI groups were VL 157/801 (19.6%), L 165/801 (20.6%), M 226/801 (28.2%), H 142/801 (17.7%), and VH 111/801 (13.9%). Overall, 117/801 (14.6%) patients were obese, 141/801 (17.6%) patients were hypertensive, and 209/801 (26.1%) patients had LVH. Obesity within COI groups was VL 34/157 (21.7%), L 26/165 (15.8%), M 30/226 (13.3%), H 20/142 (14.1%), and VH 7/111 (6.3%). HTN-1 or HTN-2 was seen in VL 25/157 (15.9%), L 36/165 (21.8%), M 41/226 (18.1%), H 23/142 (16.2%), VH 16/111 (14.4%). LVH was present in VL 50/157 (31.9%), L 47/165 (28.5%), M 63/226 (27.9%), H 26/142 (18.3%), and VH 23/111 (20.7%). Conclusions: Youths with CHD living in lower opportunity areas have a high proportion of obesity and hypertension. Furthermore, end-organ changes are seen with a high prevalence of LVH in lower opportunity CHD youths. In conclusion, these findings support the importance of considering social determinants of health like neighborhood opportunity in assessing cardiovascular risk in CHD youths.