Racial and Educational Isolation are Associated with Worse Outcomes in Congenital Heart Disease

Sociodemographic factors influence outcomes in children with congenital heart disease (CHD). We predict an association between measures of social isolation and outcomes in infants with complex CHD. These measures, racial (RI) and educational (EI) isolation range from 0 to 1, with 0 being no isolation and 1 being fully isolated within a specific population.

We identified patients less than 1-year-old undergoing CHD surgery in North Carolina from 2008-2013. We used negative binomial and logistic regression models to assess the case-mix adjusted associations between RI and EI and length of stay, complications, mortality, and resource utilization. We quantified the association of race with these indices and outcomes.

We included 1,217 infants undergoing CHD surgery. Black infants had increased LOS (p < 0.001), other complications (p = 0.03), and death (p = 0.02). RI up to 0.3 was associated with decreased outpatient encounters (p < 0.001). RI was associated with increased inpatient encounters RI up to 0.3 (p < 0.001) but decreased for RI beyond 0.3 (p = 0.01). There was an association with increased risk of one or more emergency department visits (p = 0.001) at higher levels EI. Race and RI showed a cumulative effect with children with Black race and greater than median RI having increased LOS (p < 0.001) and fewer outpatient encounters (p = 0.02).

RI, EI, and Black race are associated with poorer outcomes. Children with Black race and greater than median levels of RI are at the highest risk of poor outcomes. These differences may be caused by differential access to resources or community support.