Examining racial and socioeconomic disparity in the pediatric heart transplant evaluation
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Published on: April 1, 2022
Waldemar F Carlo1,2, Samantha Floyd2, Frank B Pearce1,2
1Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL, USA.
Insights
This study found no racial disparities in heart transplant listing for pediatric patients. The evaluation process did not show bias, even with socioeconomic differences, suggesting equitable access to the waitlist.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Health Equity Research
Background:
- Racial disparities are documented in pediatric heart transplantation waitlisting and outcomes.
- Previous research has not extensively examined racial bias in the upstream transplant candidate evaluation process.
Purpose of the Study:
- To investigate potential racial biases in the heart transplant candidate evaluation process for pediatric patients.
- To determine if race influences final disposition (waitlisting or not) in pediatric heart transplant evaluations.
Main Methods:
- Retrospective analysis of a single-center experience (2013-2019) involving 133 pediatric patients referred for heart transplant listing.
- Race defined by family self-identification; analysis of socioeconomic factors and social barriers.
- Descriptive and comparative statistical analyses performed on evaluation outcomes.
Main Results:
- Black patients constituted 44% of referrals and 43% of those listed, with no statistically significant difference (p=0.96).
- Similar proportions of Black and White patients were deemed too well or too ill for listing.
- Despite socioeconomic challenges in 18 of 27 identified Black patients, only 5 total patients (3 Black, 2 White) were denied listing due to social barriers.
Conclusions:
- The current heart transplant evaluation process at this institution does not appear to introduce racial disparities in access to the waitlist.
- While socioeconomic and social challenges exist, they did not significantly impact listing decisions based on race in this cohort.
- Further research with larger, national cohorts is recommended to explore potential racial disparities earlier in the transplant referral and evaluation pathway.
Abstract:
Racial disparities have been reported among pediatric patients waitlisted for and undergoing heart transplantation but have not been studied further upstream in the transplant candidate evaluation process. We retrospectively studied our single-center experience in order to investigate any potential biases in the evaluation process. Results of the heart transplant evaluation in children ≤18 years old at our institution were analyzed. Primary outcome was final disposition to waitlist or not. Race was defined by family self-identification. Descriptive and comparative statistical analyses were performed. From 2013 to 2019, 133 unique patients were referred for listing consideration. While Black patients comprised 44% of the referral population and had more markers of socioeconomic disadvantage, they comprised 43% of the patients who were listed for transplantation with no significant difference between these proportions (p = .96). Black and White patients made up a similar proportion of patients deemed too well or too ill for listing. Black patients had lower annual household income estimates and rates of household marriage. Despite identifying significant social challenges in 27 patients (18 of them Black), only five patients (3 Black and 2 White) were turned down for listing due to social barriers. While limited by the small number of patients turned down for social barriers, our transplant evaluation process does not appear to result in racial disparities in access to listing. Further studies are needed using national cohorts to explore possible racial disparities upstream from waitlisting and transplantation, such as during the referral and evaluation.
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