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. 2023 Aug:259:113464.
doi: 10.1016/j.jpeds.2023.113464. Epub 2023 May 11.

Insight into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease

Joshua Mayourian  1 , Ella Brown  2 , Karina Javalkar  1 , Emily Bucholz  3 , Kimberlee Gauvreau  3 , Rebecca Beroukhim  3 , Eric Feins  4 , John Kheir  3 , John Triedman  3 , Audrey Dionne  5
Affiliations

Insight into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease

Joshua Mayourian et al. J Pediatr. 2023 Aug.

Abstract

Objective: To use neighborhood-level Child Opportunity Index (COI) measures to investigate disparities in congenital heart surgery postoperative outcomes and identify potential targets for intervention.

Study design: In this single-institution retrospective cohort study, children <18 years old who underwent cardiac surgery between 2010 and 2020 were included. Patient-level demographics and neighborhood-level COI were used as predictor variables. COI-a composite US census tract-based score measuring educational, health/environmental, and social/economic opportunities-was dichotomized as lower (<40th percentile) vs higher (≥40th percentile). Cumulative incidence of hospital discharge was compared between groups using death as a competing risk, adjusting for clinical characteristics associated with outcomes. Secondary outcomes included hospital readmission and death within 30 days.

Results: Among 6247 patients (55% male) with a median age of 0.8 years (IQR, 0.2-4.3), 26% had lower COI. Lower COI was associated with longer hospital lengths of stay (adjusted HR, 1.2; 95% CI, 1.1-1.2; P < .001) and an increased risk of death (adjusted OR, 2.0; 95% CI. 1.4-2.8; P < .001), but not hospital readmission (P = .6). At the neighborhood level, lacking health insurance coverage, food/housing insecurity, lower parental literacy and college attainment, and lower socioeconomic status were associated with longer hospital length of stay and increased risk of death. At the patient-level, public insurance (adjusted OR, 1.4; 95% CI, 1.0-2.0; P = .03) and caretaker Spanish language (adjusted OR 2.4; 95% CI, 1.2-4.3; P < .01) were associated with an increased risk of death.

Conclusions: Lower COI is associated with longer length of stay and higher early postoperative mortality. Risk factors identified including Spanish language, food/housing insecurity, and parental literacy serve as potential intervention targets.

Keywords: pediatric cardiology; pediatric heart surgery; social determinants of health.

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Conflict of interest statement

Declaration of Competing Interest J.M. was supported by an American Academy of Pediatrics Resident Research Grant. The funder/sponsor did not participate in the work. The authors have no conflicts of interest relevant to this article to disclose.

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