Socioeconomic Status and Long-term Outcomes in Single Ventricle Heart Disease
- 1 October 2020
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 146 (4)
- https://doi.org/10.1542/peds.2020-1240
Abstract
BACKGROUND: Low socioeconomic status (SES) has emerged as an important risk factor for higher short-term mortality and neurodevelopmental outcomes in children with hypoplastic left heart syndrome and related anomalies; yet little is known about how SES affects these outcomes over the long-term. METHODS: We linked data from the Single Ventricle Reconstruction trial to US Census Bureau data to analyze the relationship of neighborhood SES tertiles with mortality and transplantation, neurodevelopment, quality of life, and functional status at 5 and 6 years post–Norwood procedure (N = 525). Cox proportional hazards regression and linear regression were used to assess the association of SES with mortality and neurodevelopmental outcomes, respectively. RESULTS: Patients in the lowest SES tertile were more likely to be racial minorities, older at stage 2 and Fontan procedures, and to have more complications and fewer cardiac catheterizations over follow-up (all P < .05) compared with patients in higher SES tertiles. Unadjusted mortality was highest for patients in the lowest SES tertile and lowest in the highest tertile (41% vs 29%, respectively; log-rank P = .027). Adjustment for patient birth and Norwood factors attenuated these differences slightly (P = .055). Patients in the lowest SES tertile reported lower functional status and lower fine motor, problem-solving, adaptive behavior, and communication skills at 6 years (all P < .05). These differences persisted after adjustment for baseline and post-Norwood factors. Quality of life did not differ by SES. CONCLUSIONS: Among patients with hypoplastic left heart syndrome, those with low SES have worse neurodevelopmental and functional status outcomes at 6 years. These differences were not explained by other patient or clinical characteristics.Keywords
This publication has 41 references indexed in Scilit:
- The impact of socio-economic status on health related quality of life for children and adolescents with heart diseaseHealth and Quality of Life Outcomes, 2013
- Socioeconomic status and the brain: mechanistic insights from human and animal researchNature Reviews Neuroscience, 2010
- Socioeconomic status and the developing brainTrends in Cognitive Sciences, 2009
- Design and rationale of a randomized trial comparing the Blalock–Taussig and right ventricle–pulmonary artery shunts in the Norwood procedureThe Journal of Thoracic and Cardiovascular Surgery, 2008
- Risk Factors for Readmission After Neonatal Cardiac SurgeryThe Annals of Thoracic Surgery, 2004
- Inequality in the Early Cognitive Development of British Children in the 1970 CohortEconomica, 2003
- Reliability and validity of comprehensive health status measures in children: The Child Health Questionnaire in relation to the Health Utilities IndexJournal of Clinical Epidemiology, 2002
- The Housing/Health Relationship: What Do We Know?Reviews on Environmental Health, 2000
- A Proportional Hazards Model for the Subdistribution of a Competing RiskJournal of the American Statistical Association, 1999
- A Proportional Hazards Model for the Subdistribution of a Competing RiskJournal of the American Statistical Association, 1999