Effect of Family Socioeconomic Status on the Prognosis of Children with Epicardial Permanent Pacemaker: A 16-Year Experience at a Single Center

Abstract

Background: Epicardial permanent pacemaker (EPPM) is the first choice of treatment for bradyarrhythmia in children. The influence of family socioeconomic status (SES) on the prognosis of children with EPPM remains to be clarified. Herein, we investigated the association between family SES and prognosis of children with EPPM. Methods: Children who underwent EPPM implantation at Guangdong Provincial People's Hospital between Dec 1, 2004 and Dec 1, 2019 were enrolled in this observational cohort study. Children were followed up to 16 years for all-cause mortality and pacemaker-related reoperation. Family SES was established based on household income, occupation, and education attainment of each parent in the family. Kaplan-Meier, log-rank test, and Cox proportional hazards regression were used to analyze the effect of SES. Findings: A total of 152 children (age at operation 4·9 (4·3) years; 58 (38·2%) boys) were enrolled. 150 (98·7%) children were discharged alive, and the median follow-up time was 4·0 (2·7, 6·5) years. Survival probability at 1, 3, 5, and 10 years was 97·4% (94·9-99·9), 93·6% (89·7-97·8), 92·2% (87·4-97·2) and 80·5% (67·8-95·7), respectively. Freedom from pacemaker-related reoperation at 1, 3, and 5 years was 87·7% (79·0-97·4), 64·1% (51·7-79·4), and 47·0% (34·3-64·4), respectively. The lower the family SES, the higher the risk of all-cause death and pacemaker-related reoperation. After adjusting for age and gender, hazard ratios were 7·19 (2·33–22·16) for all-cause mortality and 6·17 (3·16–12·06) for pacemaker-related reoperation, for low versus middle-high family SES. Interpretation: Low family SES is associated with an increased risk of all-cause mortality and pacemaker-related reoperation, which is an independent risk factor for poor prognosis in children with EPPM. Targeted interventions should be adopted to alleviate socioeconomic disparities and improve outcomes in children with EPPM. Funding: National Natural Science Foundation of China (No. 82000081); National Key Research and Development Program of China (No. 2018YFC1002600). Declaration of Interest: All authors declare no competing interests. Ethical Approval: The study was approved by the Ethics Committee of Guangdong Provincial People’s Hospital (NO. GDREC2019338H(R2)).