1 Divisions of Cardiology and Critical Care Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA.
2 Department of Epidemiology & Biostatistics and the California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA.
J Am Heart Assoc. 2018 Oct 16;7(20):e010342. doi: 10.1161/JAHA.118.010342.
Background Racial/ethnic and socioeconomic disparities exist in outcomes for children with congenital heart disease. We sought to determine the influence of race/ethnicity and mediating socioeconomic factors on 1-year outcomes for live-born infants with hypoplastic left heart syndrome and dextro-Transposition of the great arteries. Methods and Results The authors performed a population-based cohort study using the California Office of Statewide Health Planning and Development database. Live-born infants without chromosomal anomalies were included. The outcome was a composite measure of mortality or unexpected hospital readmissions within the first year of life defined as >3 (hypoplastic left heart syndrome) or >1 readmissions (dextro-Transposition of the great arteries). Hispanic ethnicity was compared with non-Hispanic white ethnicity. Mediation analyses determined the percent contribution to outcome for each mediator on the pathway between race/ethnicity and outcome. A total of 1796 patients comprised the cohort (n=964 [hypoplastic left heart syndrome], n=832 [dextro-Transposition of the great arteries]) and 1315 were included in the analysis (n=477 non-Hispanic white, n=838 Hispanic). Hispanic ethnicity was associated with a poor outcome (crude odds ratio, 1.72; 95% confidence interval [CI], 1.37-2.17). Higher maternal education (crude odds ratio 0.5; 95% CI , 0.38-0.65) and private insurance (crude odds ratio, 0.65; 95% CI , 0.45-0.71) were protective. In the mediation analysis, maternal education and insurance status explained 33.2% (95% CI , 7-66.4) and 27.6% (95% CI , 6.5-63.1) of the relationship between race/ethnicity and poor outcome, while infant characteristics played a minimal role. Conclusions Socioeconomic factors explain a significant portion of the association between Hispanic ethnicity and poor outcome in neonates with critical congenital heart disease. These findings identify vulnerable populations that would benefit from resources to lessen health disparities.
在患有先天性心脏病的儿童的结局方面存在种族/民族和社会经济差异。我们旨在确定种族/民族以及中介社会经济因素对左心发育不全综合征和右旋大动脉转位活产婴儿 1 年结局的影响。
作者使用加利福尼亚州全州卫生规划和发展办公室数据库进行了一项基于人群的队列研究。纳入无染色体异常的活产婴儿。主要结局为 1 年内死亡或意料之外再次住院的复合指标，定义为左心发育不全综合征>3 次或右旋大动脉转位>1 次。与非西班牙裔白人相比，西班牙裔为参照。中介分析确定了种族/民族与结局之间途径上的每个中介对结局的贡献百分比。该队列共纳入 1796 例患者（左心发育不全综合征 964 例，右旋大动脉转位 832 例），1315 例患者纳入分析（非西班牙裔白人 477 例，西班牙裔 838 例）。西班牙裔与不良结局相关（粗比值比 1.72；95%置信区间[CI]，1.37-2.17）。较高的母亲教育程度（粗比值比 0.5；95%CI，0.38-0.65）和私人保险（粗比值比，0.65；95%CI，0.45-0.71）具有保护作用。在中介分析中，母亲教育和保险状况解释了种族/民族与不良结局之间关系的 33.2%（95%CI，7-66.4）和 27.6%（95%CI，6.5-63.1），而婴儿特征则起次要作用。
社会经济因素解释了西班牙裔与患有严重先天性心脏病的新生儿不良结局之间关联的很大一部分。这些发现确定了弱势群体，他们将受益于资源来减少健康差距。
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