Disparities in Outcomes and Resource Use After Hospitalization for Cardiac Surgery by Neighborhood Income

Anderson, Brett R.; Fieldston, Evan S.; Newburger, Jane W.; Bacha, Emile A.; Glied, Sherry

doi:10.1542/peds.2017-2432

Cited by 104 publications

(70 citation statements)

References 22 publications

(12 reference statements)

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“…The following types of mortality were analysed: in‐hospital (n = 10), infant (<1 year, n = 6), neonatal (<28 days, n = 2), postoperative (n = 2), post‐discharge (n = 3), intra‐stage (n = 2), and long‐term (>1 year, n = 6) (see Table for study‐specific definitions). Four measures of SES were reported in the included studies: area‐based poverty (n = 13), parental (maternal or paternal) or area‐based education (n = 9), individual health insurance status (n = 8), and area‐based income (n = 8) . The definitions for SES measures used in individual studies are given in Table .…”

Section: Resultsmentioning

confidence: 99%

“…The definitions for SES measures used in individual studies are given in Table . The included articles were based on US (n = 22), UK (n = 5), and Panama (n = 1) populations. Most articles included all CHD subtypes combined (n = 21), with the rest including cases of HLH or single ventricle (SV) defects (n = 5), atrioventricular septal defect (AVSD, n = 1), and a composite group of “critical” subtypes (n = 1) .…”

Section: Resultsmentioning

confidence: 99%

“…The included articles were based on US (n = 22), UK (n = 5), and Panama (n = 1) populations. Most articles included all CHD subtypes combined (n = 21), with the rest including cases of HLH or single ventricle (SV) defects (n = 5), atrioventricular septal defect (AVSD, n = 1), and a composite group of “critical” subtypes (n = 1) . Cases were ascertained from congenital anomaly registers (n = 11), the Kids Inpatient Database (KIDS, n = 4), the SV reconstruction (SVR) trial (n = 2), clinical databases (n = 2), the Paediatric Health Information system (n = 2), medical records, or hospital discharges (n = 7) .…”

Section: Resultsmentioning

confidence: 99%

“…Cases were ascertained from congenital anomaly registers (n = 11), the Kids Inpatient Database (KIDS, n = 4), the SV reconstruction (SVR) trial (n = 2), clinical databases (n = 2), the Paediatric Health Information system (n = 2), medical records, or hospital discharges (n = 7) . Many articles ascertained cases postoperatively (n = 17), with these tending to ascertain cases from medical records. All but one article ascertained cases in childhood .…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

Best

Vieira

Glinianaia

et al. 2019

Paediatric Perinatal Epid

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Background The impact of socio‐economic status (SES) on congenital heart disease (CHD)‐related mortality in children is not well established. Objectives We aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD. Data sources Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched. Study selection and data extraction We included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area‐based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate. Synthesis Meta‐analyses were performed to estimate pooled ORs for in‐hospital mortality according to health insurance status. Results Of 1388 identified articles, 28 met the inclusion criteria. Increased area‐based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post‐discharge (n = 1), infant (n = 1), and long‐term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long‐term mortality (n = 1). A meta‐analysis of four US articles showed increased unadjusted odds of in‐hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area‐based income and CHD‐related mortality was conflicting, with three of eight articles reporting significant associations. Conclusion This systematic review provides evidence that children of lower SES are at increased risk of CHD‐related mortality. As these children are over‐represented in the CHD population, interventions targeting socio‐economic inequalities could have a large impact on improving CHD survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

Best

Vieira

Glinianaia

et al. 2019

Paediatric Perinatal Epid

View full text Add to dashboard Cite

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“…A particularly novel finding in the present study was the association of decreased household income with worse inhospital survival after OHT. Andersen et al showed that children from lower‐income neighborhoods have worse mortality and higher resource utilization, including LOS and hospital costs, after cardiac surgery. Similarly, Kucik et al demonstrated an increased mortality in infants with CHD from socioeconomically disadvantaged communities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy

Bradford

Daily

Lang

et al. 2019

Pediatric Transplantation

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Data investigating the impact of household income and other factors on SV patient status‐post‐Fontan palliation after heart transplantation are lacking. We aim to evaluate factors affecting outcomes after OHT in this population. The PHIS database was interrogated for either SV or myocarditis/primary CM who were 4 years or older who underwent a single OHT. There were 1599 patients with a median age of 13.2 years (IQR: 9.3‐16.1). Total hospital costs were significantly higher in the SV group ($408 000 vs $294 000, P < 0.0001), but as median household income increased, the risk of inhospital mortality, post‐transplant LOS, and LOS‐adjusted total hospital costs all decreased. The risk of inhospital mortality increased 6.5% per 1 year of age increase at the time of transplant. Patients in the SV group had significantly more diagnoses than those in the CM group (21 vs 15, P < 0.0001) and had longer total hospital LOSs as a result of longer post‐transplant courses (25 days vs 15, P < 0.0001). Increased median household income and younger age are associated with decreased resource utilization and improved inhospital mortality in SV CHD patients who undergo OHT. In conclusion, earlier consideration of OHT in this population, coupled with improved selection criteria, may increase survival in this population.

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Association Between Neighborhood-Level Social Determinants of Health and Access to Pediatric Appendicitis Care

et al. 2022

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IMPORTANCE Presenting with complicated appendicitis, which is associated with higher rates of complications and readmissions compared with simple appendicitis, may indicate delayed access to care. Although both patient-level and neighborhood-level social determinants of health are associated with access to care, little is known about the association between neighborhood factors and access to acute pediatric surgical care. OBJECTIVE To examine the association between neighborhood factors and the odds of presenting with complicated appendicitis and unplanned postdischarge health care use. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of patients aged 18 years or younger diagnosed with appendicitis was conducted. Discharge data from October 1, 2015, to September 30, 2018, were obtained from the Pediatric Health Information System Database and linked to the Child Opportunity Index (COI) 2.0 Database. Data analysis was conducted from January 1 through July 1, 2021. EXPOSURES The COI, a composite score of zip code neighborhood opportunity level information, divided into quintiles ranging from very low to very high opportunity. MAIN OUTCOMES AND MEASURES Based on COI level, the main outcome was the odds of presenting with complicated appendicitis, which was defined using the Agency for Healthcare Research and Quality-specified International Statistical Classification of Diseases, 10th Edition, Clinical Modification codes. The secondary outcome was the odds of unplanned postdischarge health care use (emergency department visits and/or readmissions) for patients with simple and with complicated appendicitis.RESULTS A total of 67 489 patients (mean [SD] age, 10.5 [3.9] years) had appendicitis, with 31 223 cases (46.3%) being complicated. A total of 1699 patients (2.5%) were Asian, 24 234 (35.9%) were Hispanic, 4447 (6.6%) were non-Hispanic Black, and 29 234 (43.3%) were non-Hispanic White; 40 549 patients (60.1%) were male; and 32 343 (47.9%) were publicly insured. Patients living in very low-COI neighborhoods had 28% higher odds of presenting with complicated appendicitis (odds ratio, 1.28; 95% CI, 1.20-1.35) compared with those in very high-COI neighborhoods. There was no significant association between COI level and unplanned postdischarge health care use (very high COI, 20.8%; very low COI, 19.1%).

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Disparities in Outcomes and Resource Use After Hospitalization for Cardiac Surgery by Neighborhood Income

Abstract: Children from lower-income neighborhoods are at increased risk of mortality and use more resource intensive care than children from higher-income communities, even after accounting for disparities between races, payers, and centers.

Cited by 104 publications

References 22 publications

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy

Association Between Neighborhood-Level Social Determinants of Health and Access to Pediatric Appendicitis Care

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