A new study shows that children from lower income neighborhoods were less likely to survive after surgery for congenital heart defects than those from wealthier areas.
The March 2018 study in Pediatrics, “Disparities in Outcomes and Resource Utilization After Hospitalization for Cardiac Surgery by Neighborhood Income,” linked a decade’s worth of data from the Pediatric Health Information System and the U.S. Census Bureau to examine relationships between household income by zip code and motrality, length of stay, and hospital costs – over and above effects of the patient’s race, insurance status, and hospital. The researchers found that children from the lowest income neighborhoods undergoing surgery for congenital heart defects – the most common birth defects managed in the U.S. – had 18% higher odds of dying, 7 percent longer lengths of stay, and 7 percent higher treatment costs than children from the highest income neighborhoods. These neighborhood effects were similar whether procedures were high-risk or low-risk, infants or adolescents.
Investigators then compared their findings to the general pediatric population – looking at children both with and without any major chronic condition – and observed strikingly similar findings, with children from the lowest income neighborhoods having a 22 percent greater chance of dying, 3 percent longer lengths of stay, and 3 percent higher in-hospital costs than children from higher-income neighborhoods.
Study authors said possible causes for neighborhood health differences identified in previous studies were thought largely to be based on differences in hospitals, or due to variations in behavioral health, such as diet, smoking, exercise, or stress.
Given this study’s population of mostly infants undergoing largely planned cardiac operations at major children’s hospitals, however, the authors concluded that these reasons seem to fall short. They suggested that some differences in the in-utero environment, rates of prenatal diagnoses, timing in referral to subspecialty centers, and/or other conscious or unconscious biases in care may exist, among other factors that merit further study.