The Child Opportunity Index 2.0 and Disparities in Pediatric Cardiorespiratory Fitness

Abstract

ObjectiveTo evaluate the effect of neighborhood-level characteristics on cardiorespiratory fitness (CRF) via peak oxygen consumption (VO2peak) for healthy pediatric patients. Study designThe institutional cardiopulmonary exercise testing (CPET) database was analyzed retrospectively. All patients aged ≤ 18 years without a diagnosis of cardiac disease and with a maximal effort CPET were included. Patients were divided into three self-identified racial categories: White, Black, and Latinx. The Child Opportunity Index (COI) 2.0 was used to analyze social determinants of health. CRF was evaluated based on COI quintiles and race. Assessment of the effect of COI on racial disparities in CRF was performed using analysis of covariance. ResultsA total of 1,753 CPETs met inclusion criteria. The mean VO2peak was 42.1±9.8mL/kg/min. The VO2peak increased from 39.1±9.6mL/kg/min for patients in the very low opportunity cohort to 43.9 ± 9.4mL/kg/min for patients in the very high opportunity cohort. White patients had higher percent predicted VO2peak compared with both Black and Latinx patients (p<0.01 for both comparisons). The racial differences in CRF were no longer significant when adjusting for COI. ConclusionIn a large pediatric cohort, COI was associated with CRF. Racial disparities in CRF are reduced when accounting for modifiable risk factors.