The Effects of Neighborhood Socioeconomic Status on Survival Outcomes Post-Congenital Heart Surgery in Infants Público
Tailor, Shreya (Spring 2021)
Abstract
Background: Infants with serious congenital heart disease (CHD) require frequently cardiac surgery or other invasive interventions and close follow-up. Low socioeconomic status (SES) can be associated with adverse exposures or compromise access to quality care thus, placing these children at risk for poor survival outcomes.
Methods and Results: Data from the PCCC (Pediatric Cardiac Care Consortium) data set were matched with state birth registry information in Arkansas, Missouri, and Ohio to examine the relationship between neighborhood SES with one year mortality or cardiac transplant among infants who had a congenital heart surgery (n=3,536). Neighborhood SES score was developed by matching available U.S Census data to create a six-component Z score including the log of the median household income, log of the median value of housing units and the percentages of households receiving interest, dividend or net rental income, among adults 25 years of age or older, the percentage who had completed high school and the percentage who had completed college, and the percentage of employed people 16 years of age or older in executive, managerial or professional specialty occupations. Overall, survival across neighborhood SES tertiles was considered to be high [Survival Probability: 95.7%; 95% Confidence Interval (CI) 94.3, 96.7%]. The survival outcomes of patients in high tertile of the neighborhood SES score were different than the survival outcomes of patients in the low tertile. At one year, patients in the lowest
SES tertile had a 50% higher hazard of death than patients in the highest SES tertile [hazard ratio (HR) of high vs low tertile 1.50, 95% CI: 1.05, 2.14)) and a 13% higher hazard of death than patients in the middle tertile (HR 1.13; 95% CI, 0.78, 1.64). There was no significant effect modification between neighborhood SES score and covariates included in the model.
Conclusion: Survival outcomes after infantile congenital heart surgery are adversely affected by low neighborhood SES, suggesting that socioeconomic and environmental factors may be important modifiers to target if we want to improve outcomes. Future studies should further evaluate aspects of SES and environment in regard to post hospital care.
Table of Contents
Literature Review...................................................................................................................... 1
Role of Socioeconomic Status ............................................................................................................................. 3
Influence of Maternal Age at Childbirth .......................................................................................................... 4
Influence of Race and Ethnicity of Mother....................................................................................................... 5
Influence of Maternal Education Level at the Time of Birth.......................................................................... 6
Utilizing Neighborhood Socioeconomic Status ................................................................................................. 7
Purpose of this Study .......................................................................................................................................... 9
Methods .................................................................................................................................... 10
Exposure Ascertainment................................................................................................................................... 10
Outcome Ascertainment ................................................................................................................................... 12
Covariates of Interest........................................................................................................................................ 14
Statistical Analysis............................................................................................................................................. 14
Results ...................................................................................................................................... 16
Neighborhood SES Score and One Year Transplant-Free Survival ............................................................ 16
Effect Modification of CHD Severity and State of Residence at Birth......................................................... 21
Discussion................................................................................................................................. 22
References ................................................................................................................................ 26
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