Applying Interventions to Address the Social Determinants of Health and Reduce Health Disparities in Congenital Heart Disease Patients

Cherestal, Bianca; Hudson, Zuri; Lopez, Keila N.

doi:10.1007/s12170-022-00710-1

Cited by 3 publications

(4 citation statements)

References 53 publications

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“…These interventions include community-based participatory research, poverty-targeted interventions to provide basic needs to families caring for children with chronic health conditions (eg, transportation, food security), and collaboration with governmental representatives to increase advocacy on state and federal levels. 28 Our study and other published literature on this topic support the inclusion of screening practices within inpatient and outpatient congenital cardiology care to understand socioeconomic limitations (eg, transportation) that may impact outcomes to identify and provide targeted interventions. 28…”

Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 61%

“…28 Our study and other published literature on this topic support the inclusion of screening practices within inpatient and outpatient congenital cardiology care to understand socioeconomic limitations (eg, transportation) that may impact outcomes to identify and provide targeted interventions. 28 There are several weaknesses of our study. As we utilized birth certificate data; thus, we were only able to identify infants who had cyanotic congenital heart disease and did not have access to additional details on the specific lesion.…”

Section: Discussionsupporting

confidence: 61%

“…and collaboration with governmental representatives to increase advocacy on state and federal levels. 28 Our study and other published literature on this topic support the inclusion of screening practices within inpatient and outpatient congenital cardiology care to understand socioeconomic limitations (eg, transportation) that may impact outcomes to identify and provide targeted interventions. 28 There are several weaknesses of our study.…”

Section: Discussionsupporting

confidence: 61%

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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: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 61%

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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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Impact of Social Determinants of Health on Predictive Models for Outcomes After Congenital Heart Surgery

Crook,

Dragan,

Woo

et al. 2024

Journal of the American College of Cardiology

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Parent and healthcare professional experiences of critical congenital heart disease in New Zealand to advance health equity

Watkins,

Ward,

Brown

et al. 2024

BMC Health Serv Res

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Background Higher odds of survival have been reported in European infants compared to Indigenous Māori and Pasifika infants with critical congenital heart disease in New Zealand. We therefore aimed to understand how to mitigate this disparity by investigating the parent and healthcare professional experiences’ of critical congenital heart disease healthcare in New Zealand. Methods A prospective qualitative study utilising semi-structured interviews was conducted on a cohort of purposefully sampled parents and health professionals with experience of critical congenital heart disease healthcare in New Zealand. Parents were recruited after a fetal critical congenital heart disease diagnosis and offered two interviews at least three months apart, whilst multidisciplinary fetal and cardiosurgical health professionals were interviewed once. Interviews were recorded and transcribed verbatim before coding, categorization and qualitative analysis. Results During 2022 and 2023, 45 people participated in 57 interviews (25 parents: 19 mothers, 6 fathers; Indigenous Māori, n = 5; Pasifika, n = 6; Asian, n = 4; European, n = 10; and 20 healthcare professionals: European n = 17). The three lessons learned from participants were: (1) Minoritized groups experience disparate healthcare quality; (2) healthcare systems are under-resourced to provide equitable support for the differential needs of grieving parents; and (3) healthcare systems could engage minoritized families more optimally in shared decision-making. Conclusions According to the experiences of parents and healthcare professionals, persisting inequities in CCHD healthcare quality occur by ethnic group, with the New Zealand healthcare system privileging European families. The concepts from this study could be translated by healthcare leaders, policymakers, and professionals into evidence-based healthcare system improvements to enhance experiences for non-European families more broadly.

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Applying Interventions to Address the Social Determinants of Health and Reduce Health Disparities in Congenital Heart Disease Patients

Cited by 3 publications

References 53 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

Impact of Social Determinants of Health on Predictive Models for Outcomes After Congenital Heart Surgery

Parent and healthcare professional experiences of critical congenital heart disease in New Zealand to advance health equity

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