Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease

Santana, Stephanie; Peyvandi, Shabnam; Costello, John M.; Baer, Rebecca J.; Collins, James W.; Branche, Tonia; Jelliffe‐Pawlowski, Laura L.; Steurer, Martina A.

doi:10.1016/j.jpeds.2022.06.036

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…AMFE was not associated with 1-year death and thus did not qualify as a mediator. In our prior study using an administrative Californian database, 12 found that AMFE was mediating a significant percentage of health care disparities. However, in that investigation, we used composite outcomes such as death and neonatal or cardiac morbidity-when assessing the association between AMFE and death alone, there was no significant association, which is consistent with the current study.…”

Section: Discussionmentioning

confidence: 97%

“…We modified our previously published AMFE definition based on the available birth certificate date 12 : it included any of the following maternal conditions: pregestational or gestational diabetes, pregestational or gestational hypertension, preeclampsia, eclampsia or maternal body mass index >35. For the small number of patients where these conditions were unknown, they were set to not-present.…”

Section: Methodsmentioning

confidence: 99%

“…To define SE position 2 widely used socioeconomic factors available in this dataset were used: maternal education level and insurance status. We classified maternal education levels into 4 groups: (0) did not complete high school, (1) completed high school (or some college but no degree), (2) WHAT IS KNOWN 12 : it included any of the following maternal conditions: pregestational or gestational diabetes, pregestational or gestational hypertension, preeclampsia, eclampsia or maternal body mass index >35. For the small number of patients where these conditions were unknown, they were set to not-present.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

“…10,11 Our group showed that an impaired maternal fetal environment (AMFE, defined as any of the following: pregestational or gestational diabetes, pregestational or gestational hypertension, preeclampsia, eclampsia, placental abruption or maternal body mass index >35) is more prevalent in Black people giving birth and explains part of the higher death and morbidity of Black infants with severe CHD in California. 12 Therefore, we analyzed a national dataset of linked live-births and deaths to determine the contribution of socioeconomic factors and AMFE to race/ethnic group disparities in the rates of first-year death among neonates with cyanotic CHD. We hope to identify factors that may lead to targeted interventions to improve outcomes of this vulnerable population.…”

mentioning

confidence: 99%

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Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Steurer-Muller

McCulloch

Santana

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Racial inequities in congenital heart disease (CHD) outcomes are well documented, but contributing factors warrant further investigation. We examined the interplay between race, socioeconomic position, and neonatal variables (prematurity and small for gestational age) on 1-year death in infants with CHD. We hypothesize that socioeconomic position mediates a significant part of observed racial disparities in CHD outcomes. METHODS: Linked birth/death files from the Natality database for all liveborn neonates in the United States were examined from 2014 to 2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) and Hispanic infants were compared with non-Hispanic White (NHW) infants. The primary outcome was 1-year death. Socioeconomic position was defined as maternal education and insurance status. Variables included as mediators were prematurity, small for gestational age, and socioeconomic position. Structural equation modeling was used to calculate the contribution of each mediator to the disparity in 1-year death. RESULTS: We identified 7167 NHW, 1393 NHB, and 1920 Hispanic infants with cyanotic CHD. NHB race and Hispanic ethnicity were associated with increased 1-year death compared to NHW (OR, 1.43 [95% CI, 1.25–1.64] and 1.17 [95% CI, 1.03–1.33], respectively). The effect of socioeconomic position explained 28.2% (CI, 15.1–54.8) of the death disparity between NHB and NHW race and 100% (CI, 42.0–368) of the disparity between Hispanic and NHW. This was mainly driven by maternal education (21.3% [CI, 12.1–43.3] and 82.8% [CI, 33.1–317.8], respectively) while insurance status alone did not explain a significant percentage. The direct effect of race or ethnicity became nonsignificant: NHB versus NHW 43.1% (CI, −0.3 to 63.6) and Hispanic versus NHW −19.0% (CI, −329.4 to 45.3). CONCLUSIONS: Less privileged socioeconomic position, especially lower maternal education, explains a large portion of the 1-year death disparity in Black and Hispanic infants with CHD. These findings identify targets for social interventions to decrease racial disparities.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Steurer-Muller

McCulloch

Santana

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Risk of in-hospital Deterioration for Children with Single Ventricle Physiology

et al. 2023

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Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality.Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality.We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014-2018 for children < 18 years old. We de ned clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and de ned infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events.Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001).Deterioration was associated with administration of additional oxygen support (p = 0.012), a uid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001).Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

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Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy

Mattia,

Coronado,

Garn

et al. 2024

Pediatr Cardiol

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Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease

Cited by 13 publications

References 32 publications

Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Risk of in-hospital Deterioration for Children with Single Ventricle Physiology

Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy

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