Socio-economic disparities in unplanned hospital admission and in- hospital outcomes among children with congenital heart disease

Abstract

Unplanned/non-elective admissions have been associated with worse clinical outcomes and increased use of hospital resources. We hypothesize that children with congenital heart disease (CHD) from lower socio-economic status backgrounds have higher rates of unplanned hospital admissions and increased hospital resource utilization. We used Kids’ Inpatient Database (2016 and 2019). We included children < 21 years of age with CHD, and excluded newborn hospitalization. We further categorized CHD into simple lesions, complex bi-ventricular lesions, and single ventricle lesions. Admission types were further divided into surgical and non-surgical admissions. We used a logistic regression model to calculate the risk of unplanned hospital admission, mortality, and hospital resource utilization in children with different socio-economic status backgrounds. Out of 4,722,684 admitted children, excluding those with newborn hospitalization, 199,757 had CHD and met the study criteria. 121,626 had mild CHD, 61,639 complex bi-ventricular lesions, and 16,462 single ventricle lesions. Surgical admission comprised 20%(n = 39,694). In the CHD cohort, 27% had elective admissions, while 73% had non-elective admissions. Mortality was higher in unplanned admissions vs elective admissions, 3.0% vs 0.93%, P < 0.001. Unplanned admissions were more common in lowest income neighborhoods vs highest income neighborhoods, aOR = 1.4(1.3–1.5), P < 0.001 and were consistent at different age groups. There were higher rates of unplanned admissions in lowest income neighborhoods for each category of CHD and for both medical and surgical admission groups. Lengths of hospitalization were longer in the poorest neighborhood compared to their wealthiest counterparts, median of 7 days (IQR 3–21) vs 6 (3–17), P < 0.001. In conclusion, children with CHD who live in lowest income neighborhoods have increased odds of unplanned hospitalization for both surgical and non-surgical admissions and have higher mortality and resource utilization.