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Published on: February 2, 2024
Socioeconomic Factors Influencing Pediatric Peak Oxygen Consumption Prediction
Maanasi S Mistry1, Kimberlee Gauvreau2, Mark E Alexander1
1Department of Cardiology, Boston Children's Hospital, Boston, MA.
Insights
Socioeconomic status significantly impacts pediatric cardiovascular fitness, showing lower predicted peak oxygen consumption in lower-income children. Social determinants of health are crucial for interpreting fitness data in children.
Area of Science:
- Pediatric Cardiology
- Exercise Physiology
- Health Disparities
Background:
- Cardiovascular fitness, measured by predicted peak oxygen consumption (pVO2), is a key health indicator in children.
- Standard demographic factors are typically used to interpret pVO2, but the influence of socioeconomic status (SES) is less understood.
Purpose of the Study:
- To investigate whether socioeconomic status (SES) has a greater impact than standard demographic variables on predicted peak oxygen consumption (pVO2) in pediatric patients.
- To determine if SES is a significant confounder in the interpretation of pVO2 data.
Main Methods:
- Retrospective analysis of maximal cardiopulmonary exercise test (CPET) data from healthy patients aged <19 years.
- Data included body mass index percentile (BMI%) and adjusted gross income (AGI) as a surrogate for SES.
- Mean percent predicted pVO2 (pppVO2) was compared between groups and analyzed using linear regression.
Main Results:
- Lower pppVO2 was observed in Black and Latinx children compared to White children.
- A significant inverse correlation was found between AGI and pppVO2, indicating lower fitness with decreased income.
- Adjusting for BMI% did not eliminate racial differences in pppVO2, but adjusting for AGI did, suggesting SES is a primary driver of these disparities.
Conclusions:
- Lower socioeconomic status is strongly correlated with reduced cardiovascular fitness in children.
- Social determinants of health, particularly income, significantly influence pVO2 and must be considered when interpreting pediatric fitness data.
- Recognizing social inequities is essential for accurate assessment and clinical decision-making regarding pediatric cardiovascular health.
Objective:
To determine if socioeconomic status (SES) has a greater effect than standard demographic values on predicted peak oxygen consumption (pVO2).
Study Design:
We conducted a single-institution, retrospective analysis of maximal cardiopulmonary exercise test (CPET) data from 2010 to 2020 for healthy patients age <19 years with body mass index (BMI) percentile (BMI%) between 5-95. Data were sorted by self-identified race, BMI%, and adjusted gross income (AGI); AGI served as a surrogate for SES. Mean percent predicted pVO2 (pppVO2) was compared between groups. Linear regression was used to adjust for differences.
Results:
A total of 541 CPETs met inclusion criteria. Mean pppVO2 was 97% ± 22.6 predicted (P < .01) with 30% below criterion standard for normal (85% predicted). After excluding unknown AGI and race, 418 CPETs remained. Mean pppVO2 was lower for Blacks (n = 36) and Latinx (n = 26) compared with Whites (n = 333, P < .01). Mean pppVO2 declined as AGI decreased (P < .01). The differences in pppVO2 between racial categories remained significant when adjusted for BMI% (Black r = -7.3, P = .035; Latinx r = -15.4, P < .01). These differences both decreased in magnitude and were no longer significant when adjusted for AGI (Black r = -6.0, P = .150; Latinx r = -9.3, P = .06).
Conclusions:
Lower SES correlates with lower measured cardiovascular fitness and may confound data interpretation. When using normative reference ranges in clinical decision making, providers should recognize that social determinants of health may influence predicted fitness. Social inequities should be considered when assessing pediatric cardiovascular fitness.
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