Abstract
Socioeconomic status (SES) affects a range of health outcomes but has not been extensively explored in the single ventricle population. We investigate the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. Retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative who underwent staged single ventricle palliation examining mortality and length of stay (LOS) using a community-level deprivation index (DI). 974 patients met inclusion criteria. Overall mortality was 20.5%, with 15.7% of deaths occurring between the first and second palliations. After adjusting for clinical risk factors, the DI was associated with death (log relative hazard \({\chi }_{3}^{2}\) = 8.92, p = 0.030) and death or transplant (log relative hazard \({\chi }_{3}^{2}\) = 8.62, p = 0.035) in a non-linear fashion, impacting those near the mean DI. Deprivation was associated with LOS following the first surgical palliation (S1P) (p = 0.031) and overall hospitalization during the first year of life (p = 0.018). For every 0.1 increase in the DI, LOS following S1P increased by 3.35 days (95% confidence interval 0.31–6.38) and total hospitalized days by 5.08 days (95% CI 0.88–9.27). Community deprivation is associated with mortality and LOS for patients with single ventricle congenital heart disease. While patients near the mean DI had a higher hazard of one year mortality compared to those at the extremes of the DI, LOS and DI were linearly associated, demonstrating the complex nature of SES factors.
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Data Availability
The de-identified data that support the findings of this study are available upon request from the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) through their standard report request process and with appropriate human subject protections assured.
Code Availability
The R codes for running the statistical analyses are available upon request from corresponding authors.
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Current funding sources for National Pediatric Cardiology Quality Improvement Collaborative include (1) participation fees from enrolled centers; (2) a grant from the Children’s Heart Association of Cincinnati; (3) a federal grant to the pediatric Center for Education and Research in Therapeutics at Cincinnati Children’s Hospital Medical Center, funded by the federal Agency for Healthcare, Research and Quality [#U19HS021114 AHRQ]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SL, KS, HZ, and NO. The first draft of the manuscript was written by SL and KS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This research study was conducted retrospectively from data obtained from infants enrolled in the National Pediatric Cardiology Quality Improvement Collaborative and was in accordance with the ethical standards of our institution and with the 1964 Helsinki declaration and its later amendments of comparable ethical standards. The protocol was reviewed and approved by the IRB of Cincinnati Children’s Hospital Medical Center using an expedited review in accordance with 45 CFR 46.11(b)(1).
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Sarah R. de Loizaga and Kristin Schneider are considered as the co First authors.
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de Loizaga, S.R., Schneider, K., Beck, A.F. et al. Socioeconomic Impact on Outcomes During the First Year of Life of Patients with Single Ventricle Heart Disease: An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry. Pediatr Cardiol 43, 605–615 (2022). https://doi.org/10.1007/s00246-021-02763-2
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DOI: https://doi.org/10.1007/s00246-021-02763-2