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Mortality, resource use in pediatric cardiac surgery vary by neighborhood income
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Among children and adolescents who undergo cardiac surgery, those from lower-income neighborhoods have worse mortality rates and use more resources compared with those from higher-income neighborhoods, according to new findings.
The association persisted even after adjustment for race, payers and centers.
“There have been improvements in pediatric cardiac surgery over the last 10 years, but there are still differences in outcomes,” Brett R. Anderson, MD, MBA, MS, attending pediatric cardiologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and assistant professor of pediatrics at Columbia University Irving Medical Center, told Cardiology Today. “There has been discussion as to whether the disparities are based on income or race. We found an additive effect of the income of the family, race and the neighborhood from which you come.”
Anderson and colleagues used data from the Pediatric Health Information System database and the U.S. Census Bureau between 2005 and 2015 to determine, regardless of race or payer, associations between annual household income by ZIP code and the following factors: mortality, length of stay, inpatient standardized costs and costs per day in children who underwent cardiac surgery at 46 institutions (n = 101,013). A similar analysis was performed for all pediatric hospitalizations between 2012 and 2015 (n = 857,833) at the same institutions.
Participants were stratified into quartiles by median community-level income.
Compared with those from the highest quartile of neighborhood income, those in the lowest quartile had increased odds of mortality (OR = 1.18; 95% CI, 1.03-1.35), a 7% longer length of stay (95% CI, 1-14) and 7% higher standardized costs (95% CI, 1-14), but no differences in costs per day, Anderson and colleagues wrote.
Differences in race, payer or centers could only partially explain the results, according to the researchers.
Similar results were seen in the analysis of all pediatric hospitalizations.
“There are disparities from three different perspectives: your household income, your race and the neighborhood you come from,” Anderson said in an interview. “Clinicians need to be aware of this as we think about how to take care of our children. You can be a high-income kid living in a low-income neighborhood, or a low-income kid living in a high-income neighborhood, and still have worse outcomes. Until we further understand the mechanisms behind these discrepancies, clinicians need to look introspectively and try to understand whether we are managing patients differently. Is there some way in which the care we are providing is different for these patients?” – by Erik Swain
For more information:
Brett R. Anderson, MD, MBA, MS, can be reached at Division of Pediatric Cardiology, Columbia University Medical Center, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, 3959 Broadway, New York, NY 10032; email: bra2113@cumc.columbia.edu.
Disclosures: The authors report no relevant financial disclosures.
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