Abstract
<h3>Purpose</h3> Socioeconomic disparities negatively impacts outcomes in heart transplantation (HTx). However, the impact of insurance status and the social construct of race in pediatric patients has not been well studied. <h3>Methods</h3> The Pediatric Heart Transplant Society registry was queried between January 1, 2000- December 31, 2019. Patients were stratified by insurance status: US government (USG), US private (USP) and Single Payer (SP, UK & Canada) and race (black, white, other). Patients with a selection of more than one race were classified as other. Outcomes after HTx were assessed by Kaplan Meier log rank test including graft survival, time to first cardiac allograft vasculopathy (CAV), rejection, hemodynamic compromised (HC) rejection, and malignancy. <h3>Results</h3> 5879 children underwent HTx with insurance status as follows: 2800 USG (48%), 2431 USP (41%) and 648 SP (11%). Race breakdown included: 4086 white, 1052 black and 936 other. At 10 years post-transplant, graft survival (65.8% USG, 72.6% USP, 77% SP, p=.0005), time to first CAV (73.5% USG, 77.7% USP, 94.6% SP, p<.0001), rejection (43.0% USG, 48.7% USP, 79.2% SP, p <.0001), and HC rejection (71.2% USG, 79.3% USP, 95.7% SP, p<.0001) outcomes were worse in USG followed by USP and then SP patients. When stratifying insurance by race, blacks with USG and USP had worse outcomes with the shortest time to graft loss (p <.0001, Figure 1). <h3>Conclusion</h3> In this multinational analysis of pediatric HTx patients, USG was associated with worse post-HTx outcomes. When stratified by race, graft survival was worse in black patients with USG and USP insurance. Both insurance and the social construct of race contribute to worse outcomes post heart transplant and may represent disparity in access to care and other racial bias. These results highlight the importance of further work in this area.
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