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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Gender differences in the utilisation of surgery for congenital heart disease in India
Sivasubramanian Ramakrishnan1, Rohan Khera, Snigdha Jain
1Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. ramakgmc@rediffmail.com
Insights
Girls with congenital heart disease are less likely to receive corrective surgery due to gender bias and socioeconomic factors. Addressing these social determinants is crucial for equitable pediatric cardiac care.
Area of Science:
- Pediatric Cardiology
- Public Health
- Sociology
Background:
- Congenital heart disease (CHD) corrective surgery is life-saving but its utilization is influenced by socioeconomic factors.
- Girls in India may face disparities in accessing cardiac care, a concern not yet systematically studied.
Purpose of the Study:
- To investigate the factors influencing treatment compliance for pediatric cardiac surgery in India.
- To identify gender-based disparities in accessing corrective surgery for congenital heart defects.
Main Methods:
- A prospective study interviewed guardians of 405 children (up to 12 years) advised for elective pediatric cardiac surgery.
- Patient outcomes were reviewed after one year, analyzing factors associated with non-compliance.
- A qualitative sub-study involved interviews with parents of 20 children who had not undergone surgery.
Main Results:
- Only 44% of girls underwent surgery compared to 70% of boys within one year (p<0.001).
- Independent predictors of non-compliance included female gender (OR 3.46), lower socioeconomic status, and higher surgery cost.
- Qualitative data revealed concerns about girls' matrimonial prospects and lack of social support as key barriers.
Conclusions:
- Female gender is a significant determinant of non-compliance with pediatric cardiac surgery.
- Deep-seated social factors contribute to gender bias in accessing life-saving cardiac interventions for children.
Background:
Corrective surgery for congenital heart disease may be life-saving, but its utilisation depends upon several social and economic factors. Girls with cardiac defects may not receive equitable care in India, but this has not been systematically studied.
Methods:
In this prospective study, parents or guardians of 405 consecutive children aged up to 12 years (mean ± SD age 3.43 ± 3.44 years; 271 boys) who had been advised to undergo elective paediatric cardiac surgery were interviewed using a validated questionnaire. The status of the patients was reviewed after a year and the factors associated with non-compliance with treatment were analysed. In a qualitative sub-study the parents of 20 children who had not undergone surgery were interviewed. Qualitative data were analysed using an inductive analytical approach.
Results:
Of the 405 patients studied, 44% (59/134) of girls had undergone surgery at 1 year compared with 70% (189/271) of boys (χ²=24.97; p<0.001). Independent predictors for non-compliance with surgery included female gender (OR 3.46, 95% CI -2.06 to 5.80; p<0.0001), lower socioeconomic classes (lower-middle: OR 18.62, 95% CI -2.14 to 161.8, p=0.008; upper-lower: OR 34.27, 95% CI -3.72 to 316.0, p=0.002) and higher cost of surgery (OR 1.92, 95% CI -1.06 to 3.47, p=0.03). In the in-depth interviews, apprehensions about future matrimonial prospects of girls and lack of social support emerged as the major factors responsible for delays in undergoing surgery.
Conclusions:
Female gender is an important determinant of non-compliance with paediatric cardiac surgery. Deep-seated social factors underlie this gender bias.
