Racial and ethnic differences in mortality in children awaiting heart transplant in the United States

Area of Science:

• Pediatric Cardiology
• Transplant Medicine
• Health Disparities Research

Background:

• Racial disparities in pediatric heart transplant (HT) outcomes are established.
• However, data on racial and ethnic differences in mortality risk among children awaiting HT is limited.

Purpose of the Study:

• To investigate racial and ethnic disparities in wait-list mortality for children under 18 years old listed for primary heart transplant in the United States.
• To identify risk factors associated with wait-list mortality across different racial and ethnic groups.

Main Methods:

• Analysis of a cohort of 3299 children listed for primary heart transplant between 1999 and 2006 in the US.
• Utilized multivariable Cox proportional hazards models to assess the risk of wait-list mortality.
• Controlled for clinical variables (age, cardiac diagnosis, support status, renal function, blood group) and socioeconomic factors (insurance, income).

Main Results:

• Wait-list mortality rates were 14% (White), 19% (Black), 21% (Hispanic), 17% (Asian), and 27% (Other).
• Black, Hispanic, Asian, and Other children demonstrated significantly higher adjusted hazard ratios for wait-list death compared to White children.
• These disparities remained significant after adjusting for clinical and socioeconomic variables, though the latter explained a small portion of the increased risk.

Conclusions:

• Minority children awaiting heart transplant face a significantly elevated risk of mortality compared to their White counterparts.
• The findings underscore the need for further investigation into the underlying causes of these disparities and for targeted interventions to improve equity in pediatric HT care.