Racial isolation indices and educational isolation indices are predictive of outcomes among infants with congenital heart disease (CHD), according to the results of a study presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5th through 7th, in Chicago, Illinois.
Although socioeconomic status and race impact health outcomes among pediatric patients with CHD, it remains unknown whether neighborhood factors can have additional effects. With the use of previously developed measures of racial isolation indices and educational isolation indices, researchers sought to evaluate whether measures of social isolation that are implemented at the census block are linked to increased complications, resource utilization, and death among infants with CHD.
Individuals from the Centers for Disease Control and Prevention-North Carolina (CDC-NC) CHD Surveillance database between 2007 and 2012 were identified. Negative binomial and logistic regression models were used to evaluate case-mix adjusted associations between racial isolation indices and educational isolation indices, along with length of stay (LOS), mortality, postoperative complications, and resource utilization.
Racial isolation indices utilized non-Hispanic White race and educational isolation indices utilized completed college as the reference groups (on a scale from 0 to 1). Higher racial isolation index and educational isolation index values showed that non-Hispanic Black infants are residing mostly in non-Hispanic Black neighborhoods and that noncollege-educated individuals are residing in neighborhoods the comprise mainly noncollege-educated individuals.
A total of 1217 infants who had received CHD surgery at a mean age of 61 days were enrolled in the study. Of these participants, 22% were Black, 14% were Hispanic, and 34% were Medicaid patients.
Results of the study showed that overall, the median racial isolation index (25th-75th percentile) value was 0.18 (95% CI, 0.090-0.32), whereas the median educational isolation index value was 0.79 (95% CI, 0.67-0.86). Following adjustments for sex, age, race, ethnicity, disease severity, preterm birth, and LOS, a significant association was observed between racial isolation indices and outpatient encounters, with decreased utilization as the racial isolation indices increased up to 0.3 (P <.001), then increased utilization as the racial isolation indices increased beyond 0.3 (P =.017).
Non-Hispanic Black infants exhibited significantly increased LOS (P <.001), other complications (P =.025), 1 or more emergency department (ED) visits (P =.059), and death (P =.02) compared with non-Hispanic White infants when controlling for racial isolation indices. Further, an association with a significantly increased risk for 1 or more ED visits was observed with educational isolation indices greater than 0.8 (P =.001).
“Black race is associated with longer LOS, complications, ED visits and death after adjusting for patients factors including RII [racial isolation indices],” the study authors wrote. “These differences may be caused by differential access to resources or community support. Investigation into effective interventions to improve health equity is essential.”
Sooy-Mossey M, Sethi N, Mulder H, et al. Association of racial and educational isolation on outcomes in infants with congenital heart disease. Presented at: The American Heart Association (AHA) Scientific Sessions 2022; November 5-7, 2022; Chicago, IL. Abstract #MP183.