Abstract 9316: Association of Racial and Educational Isolation on Outcomes in Infants With Congenital Heart Disease

Abstract

Introduction: While race and socioeconomic status influence health outcomes in children with CHD, it is unknown whether neighborhood factors have additional effects . Hypothesis: Using previously developed measures of racial and educational isolation indices (RII, EII), we predict that measures of social isolation implemented at the census block level are associated with increased complications, resource utilization and death in infants with CHD. Methods We identified patients < 1 year old undergoing CHD surgery in the CDC- NC CHD Surveillance database (2007-2012). We used negative binomial and logistic regression models to assess the case-mix adjusted associations between RII and EII and length of stay (LOS), mortality, post-operative complications, and resource utilization. RII used non-Hispanic White (NHW) race and EII used completed college as the reference groups (scale 0-1). Higher values of RII and EII indicate that NHBs are living in mostly NHB neighborhoods and non-college educated individuals are living in neighborhoods composed of mostly non-college educated individuals, respectively. Results: We included 1,217 infants who had CHD surgery at a mean age of 61 days (22% Black race, 14% Hispanic, and 34% Medicaid). Overall median RII (25 th -75 th ) score was 0.18 (0.09-0.32) and EII was 0.79 (0.67-0.86). After adjusting for age, sex, race, ethnicity, disease severity, preterm birth and LOS, there was an association between RII and outpatient encounter with decreased utilization as RII increases up to 0.3 (p<0.001), then increased utilization as RII increases beyond 0.3 (p=0.017). NHB infants had increased LOS (p<0.001), other complications (p=0.025), ≥1 ED visit (p=0.059), and death (p=0.02) compared to NHW infants when controlling for RII. There was an association with a significantly increased risk of ≥1 ED visit (p=0.001) at EII above 0.8. Conclusions: RII is associated with outpatient encounters in a non-linear fashion. Black race is associated with longer LOS, complications, ED visits and death after adjusting for patient factors including RII. These differences may be caused by differential access to resources or community support. Investigation into effective interventions to improve health equity is essential.