O2042: Neighborhood Childhood Opportunity and Pediatric Cardiac Catheterization Outcomes

Background: The association between socioeconomic status (SES) and outcomes in congenital heart disease has been demonstrated in several settings. However, to our knowledge, the association between SES and risk of adverse outcomes during pediatric-congenital cardiac catheterization has not been assessed.

Project Description: Catheterizations in all patients ≤18 years in the Congenital Cardiac Catheterization Project on Outcomes (C3PO) from 2014-2017 and 2019-2021 were included. Patient and procedure-level data from C3PO were linked with ZIP code level Childhood Opportunity Index (COI) 2.0, as a proxy for individual-level SES. The primary outcome was high severity adverse events (HSAE), defined as death (level 5) or level 3c/4 adverse events. Multivariable logistic regression models were fit to evaluate the association between COI and HSAE, adjusting for several sets of measurable confounders.

Discussion: In total, 26,358 catheterizations at 12 centers were included. Of these, 12% (n=3209) were performed in neonates, 20% (n=5298) in other infants, and 30% (n=7786) in 1-5 year old children with 53% of cases involving interventions (n=13,563). In terms of race/ethnicity, 65% of catheterizations were in non-Hispanic white (n=17,177), 13% in non-Hispanic black (n=3548), and 7% in Hispanic patients (n=1788). Catheterizations occurred in 51% of patients with commercial insurance (n=13,396), 41% with public insurance (n=10,804), and 2% without insurance (n=429). Lower COI quintile was associated with higher likelihood of HSAE, ranging from 1.7% in the very high COI group (n=101) to 2.3% in the very low COI group (n=106) (p=0.001). In adjusted analyses, patients in the very low, low, and high COI quintiles had statistically significantly increased odds of HSAE compared to the very high COI quintile (Table 1).

Conclusion: Lower neighborhood childhood opportunity is independently associated with higher odds of HSAE in children undergoing cardiac catheterization. Interventions focused on children and families from lower opportunity neighborhoods may mitigate these disparities.