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

Joshua Mayourian; Ella Brown; Karina Javalkar; Emily Bucholz; Kimberlee Gauvreau; Rebecca Beroukhim; Eric Feins; John Kheir; John Triedman; Audrey Dionne

doi:10.1016/j.jpeds.2023.113464

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

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

Authors

Affiliations

¹ Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston University, Boston, MA.
² Department of Cardiology, Boston Children's Hospital, Boston, MA.
³ Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA.
⁴ Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.
⁵ Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA. Electronic address: audrey.dionne@cardio.chboston.org.

PMID: 37172810
DOI: 10.1016/j.jpeds.2023.113464

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cardiac Surgical Procedures*
Child
Child, Preschool
Female
Heart Defects, Congenital* / surgery
Humans
Infant
Male
Patient Readmission
Retrospective Studies
Treatment Outcome