Structural Racism, Social Determinants of Health, and Provider Bias: Impact on Brain Development in Critical Congenital Heart Disease.

Abstract

Critical congenital heart disease (cCHD) has neurodevelopmental sequelae that can carry into adulthood, which may be due to aberrant brain development or brain injury in the prenatal and perinatal/neonatal periods and beyond. Health disparities based upon the intersection of sex, geography, race, and ethnicity have been identified for poorer pre- and postnatal outcomes in the general population, as well as those with cCHD. These disparities are likely driven by systemic racism, disparities in social determinants of health (SDOH), and provider bias, which further compound negative brain development outcomes. The current review discusses how aberrant brain development in cCHD early in life is impacted by reduced access to quality care (i.e., prenatal care and testing, postnatal care) due to divestment in non-White neighborhoods (e.g., redlining) and food insecurity, differences in insurance status, location of residence, and perceived interpersonal racism and bias which disproportionately affects pregnant people of color who have fewer economic resources. Suggestions are discussed for moving forward with implementing strategies in medical education, clinical care, research, and gaining insight into the communities served to combat disparities and bias while promoting cultural humility.