Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.
University of North Carolina Children's Hospital, Chapel Hill, NC, USA.
Pediatr Transplant. 2023 May;27(3):e14412. doi: 10.1111/petr.14412. Epub 2022 Nov 3.
The US Pediatric Heart Allocation Policy (PHAP) was revised in March 2016, with the goal of reducing waitlist mortality. We evaluated the hypothesis that these changes, which increased status exceptions, have worsened racial disparities in waitlist outcomes.
Children in the Pediatric Heart Transplant Study database listed for first heart transplant from January 2012 - June 2020 were included and stratified by listing before (Era 1) or after (Era 2) the PHAP revision.
A total of 4,089 children were listed during the study period. Compared with white children (n = 2648), non-white children (n = 1441) were more likely to have an underlying diagnosis of cardiomyopathy in both eras. Waitlist mortality was similar in white and non-white children in Era 1, but comparatively worse for non-white children in Era 2. In multivariable analysis controlling for diagnosis, age, and severity markers, non-white children had a significantly higher waitlist mortality only in Era 2 (Era 1: sHR 1.22 [95%CI 0.90 - 1.66] vs. Era 2: sHR 1.57 [95%CI 1.17 - 2.10]).
Widening racial disparities in waitlist mortality may be an unintended consequence of the 2016 PHAP revision. Additional analyses may inform the degree to which this policy vs. unrelated changes in care differentially contribute to these disparities.
美国儿科心脏分配政策（PHAP）于 2016 年 3 月修订，旨在降低候补名单死亡率。我们评估了这样一个假设，即这些增加特殊情况的变化是否使候补名单结果的种族差异恶化。
研究纳入了 2012 年 1 月至 2020 年 6 月期间在儿科心脏移植研究数据库中接受首次心脏移植的儿童，并按 PHAP 修订前（时代 1）或后（时代 2）进行分层。
研究期间共有 4089 名儿童被列入候补名单。与白人儿童（n=2648）相比，非白人儿童（n=1441）在两个时代都更有可能患有心肌病的基础诊断。在时代 1 中，白人儿童和非白人儿童的候补名单死亡率相似，但在时代 2 中，非白人儿童的死亡率相对较高。在控制诊断、年龄和严重程度标志物的多变量分析中，非白人儿童仅在时代 2的候补名单死亡率显著更高（时代 1：sHR 1.22[95%CI 0.90-1.66] vs. 时代 2：sHR 1.57[95%CI 1.17-2.10]）。
候补名单死亡率的种族差异扩大可能是 2016 年 PHAP 修订的意外后果。进一步的分析可能会说明该政策与护理中无关的变化在多大程度上导致了这些差异。
