Social Determinants of Health Impact Readmission Risk in Pediatric Cardiac Disease

In the setting of pediatric cardiac disease, children who are from under-resourced areas or underrepresented populations were at increased risk for 90-day readmission, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5th through 7th, in Chicago, Illinois.

It is established that social determinants of health (SDoH) impacts pediatric readmissions and mortality, however, there has been little investigation on how SDoH affects readmission and mortality in pediatric cardiac disease.

To evaluate the relationship between SDoH and pediatric cardiac disease, researchers from Boston Children’s Hospital conducted a multicenter retrospective study. Children (N=161,039) with a cardiac diagnosis included in the Pediatric Health Information System database between 2017 and 2020 were evaluated for 90-day outcomes on the basis of SDoH. The included SDoH variables were ethnicity, insurance, income, and child opportunity index (COI), defined as the composite variable of residential socioeconomic resources.

A total of 249,222 cardiac-related admissions occurred among the study population. The 90-day readmission rate was 22.4%, mortality rate was 2.8%, and mortality rate at readmission was 1.8%.

In the multivariate analysis, risk for 90-day readmissions was assoicated with age, ethnicity, history of cardiac surgery, non-cardiac complex chronic comorbidities, extracorporeal membrane oxygenation (ECMO), COI, and insurance status, (all P <.05).

Compared with adolescents aged 13-17 years, infants aged 30 days to <1 year were at increased risk for readmission (adjusted odds ratio [aOR], 1.28) and neonates aged <30 days (aOR, 0.73), children aged 1 to <5 years (aOR, 0.95), and children aged 5 to <13 years (aOR, 0.81) were at decreased risk for readmission.

For ethnicity, children who were Hispanic (aOR, 1.08), multiracial (aOR, 1.07), and Black (aOR, 1.05) were more likely to be readmitted, and children of other ethnicities were less likely to be readmitted (aOR, 0.94), compared with children who were White.

Children who had undergone cardiac surgery were at lower risk for readmission compared with children who had not undergone cardiac surgery (aOR, 0.69) and children with extracorporeal membrane oxygenation (ECMO; aOR, 1.23) and 1 (aOR, 1.56), 2 (aOR, 2.37), and 3 or more (aOR, 3.49) chronic noncardiac conditions were at increased risk for readmissions comapred with the children without ECMO or comorbid conditions, respectively.

For COI, compared with those who had high opportunity, those with very low or low (aOR, 1.05) and moderate (aOR, 1.02) levels of opportunity were more likely to be readmitted in 90 days.

Compared with commercial insurance, lower risk for readmissions was observed among children who self-paid (aOR, 0.87) whereas children with Medicaid (aOR, 1.26), other governmental insurance (aOR, 1.15), or other payor insurance (aOR, 1.14) were at elevated risk.

In a subanalysis of 38,711 children who had cardiac surgical admissions, 15.8% were readmitted and a similar pattern in readmissions as the main analysis was observed with regard to ethnicity and insurance.

This study found that among children with cardiac disease, risk for 90-day readmissions was elevated among children from under-resourced areas or underrepresented groups, indicating that SDoH likely affects outcomes in pediatric cardiac disease.

 “Our data provide insights for future inventions to optimize hospital discharge planning in this population,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.