Racial and Ethnic Disparities Persist in the Current Era of Pediatric Heart Transplantation

Amdani, Shahnawaz; Bhimani, Salima; Boyle, Gerry; Liu, Wei; Worley, Sarah; Saarel, Elizabeth V.; Hsich, Eileen

doi:10.1016/j.cardfail.2021.05.027

Cited by 48 publications

(32 citation statements)

References 27 publications

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“…The association between non‐White racial or ethnic identity and rejection was consistently demonstrated across studies from the US and Canada, 8,40,71,72 including after adjusting for sociodemographic, recipient, and donor clinical characteristics 12,69 . Studies also demonstrated this association over time, including increased rates of late first acute rejection (i.e., >12 months from transplant), 73 and within the first 3 years post‐transplant among Black children compared to White and Hispanic children 26 . One US study found no difference in the number of rejections across racial groups; however, a larger proportion of Black participants had two or more rejections compared to White recipients or those of other identified racial or ethnic identities 74 .…”

Section: Resultsmentioning

confidence: 71%

“…Findings regarding waitlist mortality were similarly inconsistent, including some finding similar rates among Black and White children, but higher rates among Hispanic children, 23,25 while other studies found greater risk of waitlist mortality among Black children compared to White children after adjusting for other clinical risk factors, insurance, and/or geographic regional variables 17,26,27 . Additionally, one study demonstrated no differences in mortality across patients of Hispanic or non‐Hispanic ethnicity 17 while another found lower risk of waitlist mortality among Hispanic children 28 …”

Section: Resultsmentioning

confidence: 99%

“…Two studies found no differences in prolonged hospitalization following transplant across racial or ethnic identities, 26,69 although Black children were significantly more likely than White or Hispanic children to be hospitalized for rejection 3 years post‐transplant 26 …”

Section: Resultsmentioning

confidence: 99%

“…12,69 Studies also demonstrated this association over time, including increased rates of late first acute rejection (i.e., >12 months from transplant), 73 and within the first 3 years post-transplant among Black children compared to White and Hispanic children. 26 One US study found no difference in the number of rejections across racial groups; however, a larger proportion of Black participants had two or more rejections compared to White recipients or those of other identified racial or ethnic identities. 74 A Canadian study found 1-year rejection rates were similar across Aboriginal and non-Aboriginal recipients, while late rejection rates were higher in Aboriginal recipients.…”

Section: Rejectionmentioning

confidence: 98%

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A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Rejectionmentioning

confidence: 98%

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A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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“…In a recent SRTR study, Black children had a 25% higher mortality rate while on the transplant waitlist compared with White children. 11 This may suggest that Black children at higher risk of perioperative stroke are less likely to survive to receive a heart transplant than White children on the transplant waitlist. Therefore, among waitlist survivors, the (lower risk) Black recipients had a lower rate of perioperative stroke compared with White children.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Incidence and Prognosis of Perioperative Stroke Among Pediatric Cardiac Transplant Recipients

Lehman

Mostofsky

Salia

et al. 2022

JAHA

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Background In the general population, Black children have a higher incidence of stroke and all‐cause mortality after stroke than White children. Beginning 6 months following cardiac transplantation, Black children have higher mortality than White children. However, whether there are racial and ethnic disparities in incidence and all‐cause mortality following perioperative stroke among pediatric cardiac transplant recipients is unknown. Methods and Results Using the Scientific Registry of Transplant Recipients, we studied children who underwent their first heart transplant in the United States between January 1994 and September 2019. Using multivariable logistic regression, we assessed the association between race and ethnicity and perioperative stroke. We used multivariable piecewise Cox regression to examine the association between race and ethnicity and mortality among survivors of perioperative stroke. Among 8224 children who had a first cardiac transplant, 255 (3%) had a perioperative stroke. Black children had 32% lower odds of perioperative stroke compared with White children (adjusted odds ratio, 0.68 [95% CI, 0.46–0.996]). Following perioperative stroke, mortality rates were similar for Black and White children in the first 6 months (adjusted hazard ratio [HR], 0.99 [95% CI, 0.44–2.26]). However, Black children had a higher mortality rate than White children beyond 6 months (adjusted HR, 3.36 [95% CI, 1.22–9.22]). Conclusions Among pediatric cardiac transplant recipients, Black children have a lower incidence of perioperative stroke than White children. Among survivors of perioperative stroke, mortality is initially similar by race and ethnicity, but beyond 6 months, Black children have over a 3‐fold higher mortality rate than White children. Identifying and intervening on potential differences in care is essential to addressing these disparities.

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Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia

et al. 2023

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ImportanceThere is some data to suggest that racial and ethnic minority infants with congenital diaphragmatic hernia (CDH) have poorer clinical outcomes.ObjectiveTo determine what patient- and institutional-level factors are associated with racial and ethnic differences in CDH mortality.Design, Setting, and ParticipantsMulticenter cohort study of 49 US children’s hospitals using the Pediatric Health Information System database from January 1, 2015, to December 31, 2020. Participants were patients with CDH admitted on day of life 0 who underwent surgical repair. Patient race and ethnicity were guardian-reported vs hospital assigned as Black, Hispanic (White or Black), or White. Data were analyzed from August 2021 to March 2022.ExposuresPatient race and ethnicity: (1) White vs Black and (2) White vs Hispanic; and institutional-level diversity (as defined by the percentage of Black and Hispanic patients with CDH at each hospital): (1) 30% or less, (2) 31% to 40%, and (3) more than 40%.Main Outcomes and MeasuresThe primary outcomes were in-hospital and 60-day mortality. The study hypothesized that hospitals managing a more racially and ethnically diverse population of patients with CDH would be associated with lower mortality among Black and Hispanic infants.ResultsAmong 1565 infants, 188 (12%), 306 (20%), and 1071 (68%) were Black, Hispanic, and White, respectively. Compared with White infants, Black infants had significantly lower gestational ages (mean [SD], White: 37.6 [2] weeks vs Black: 36.6 [3] weeks; difference, 1 week; 95% CI for difference, 0.6-1.4; P &lt; .001), lower birthweights (White: 3.0 [1.0] kg vs Black: 2.7 [1.0] kg; difference, 0.3 kg; 95% CI for difference, 0.2-0.4; P &lt; .001), and higher extracorporeal life support use (White: 316 patients [30%] vs Black: 69 patients [37%]; χ21 = 3.9; P = .05). Black infants had higher 60-day (White: 99 patients [9%] vs Black: 29 patients [15%]; χ21 = 6.7; P = .01) and in-hospital (White: 133 patients [12%] vs Black: 40 patients [21%]; χ21 = 10.6; P = .001) mortality . There were no mortality differences in Hispanic patients compared with White patients. On regression analyses, institutional diversity of 31% to 40% in Black patients (hazard ratio [HR], 0.17; 95% CI, 0.04-0.78; P = .02) and diversity greater than 40% in Hispanic patients (HR, 0.37; 95% CI, 0.15-0.89; P = .03) were associated with lower mortality without altering outcomes in White patients.Conclusions and RelevanceIn this cohort study of 1565 who underwent surgical repair patients with CDH, Black infants had higher 60-day and in-hospital mortality after adjusting for disease severity. Hospitals treating a more racially and ethnically diverse patient population were associated with lower mortality in Black and Hispanic patients.

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Racial and Ethnic Disparities Persist in the Current Era of Pediatric Heart Transplantation

Cited by 48 publications

References 27 publications

A systematic review of social determinants of health in pediatric organ transplant outcomes

A systematic review of social determinants of health in pediatric organ transplant outcomes

Racial and Ethnic Disparities in Incidence and Prognosis of Perioperative Stroke Among Pediatric Cardiac Transplant Recipients

Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia

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