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Outcome Disparities Between Rural and Urban Infants with Single-Ventricle Heart Disease
Janelle Buysse1, Trudy A Pierick1, M Bridget Zimmerman2
1Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa, Iowa City, IA.
Insights
Rural infants with single-ventricle heart disease show better transplant-free survival. While urban infants have better growth, this difference is linked to demographics and disease severity, not location itself.
Area of Science:
- Pediatric Cardiology
- Public Health
- Health Outcomes Research
Background:
- Single-ventricle heart disease (SVHD) presents unique challenges for infant growth and survival.
- Environmental factors, such as urban vs. rural home location, may influence health outcomes in these vulnerable infants.
- Understanding these disparities is crucial for targeted interventions and improved care.
Purpose of the Study:
- To investigate the association between urban or rural home location and somatic growth (weight and height z scores) in infants with SVHD at one year of age.
- To evaluate the impact of home location on transplant-free survival at one year in infants with SVHD.
- To identify potential confounding factors influencing growth and survival based on geographic location.
Main Methods:
- Retrospective analysis of 1754 infants with SVHD from 67 centers (2016-2020) using the National Pediatric Cardiology-Quality Improvement Collaborative database.
- Home location classified as urban or rural based on Rural-Urban Commuting Area codes.
- Comparison of one-year weight/height z scores and transplant-free survival between urban and rural groups, with adjusted analyses for covariates and subgroup analyses.
Main Results:
- Urban infants exhibited significantly greater weight and height z scores at one year compared to rural infants (P < .01).
- After adjusting for covariates, these growth differences were no longer statistically significant (P = .21 for weight, P = .15 for height).
- Rural infants demonstrated significantly higher odds of one-year transplant-free survival compared to urban infants (OR 0.72, P < .02).
Conclusions:
- Infants with SVHD living in rural areas experience superior transplant-free survival to their first birthday.
- While urban infants show initially better growth, this disparity is explained by demographic and disease severity factors, not solely by location.
- Environmental context plays a role in SVHD outcomes, highlighting the need for location-aware healthcare strategies.
Objective:
To evaluate the impact of home location in an urban or rural environment on somatic growth and transplant-free survival in infants with single-ventricle heart disease at 1 year of age.
Study Design:
Data were reviewed from 67 centers using the National Pediatric Cardiology-Quality Improvement Collaborative database between 2016 and 2020. Urban or rural home location was determined using the home ZIP code's rural-urban commuting area code. One-year weight and height z scores and 1-year transplant-free survival were compared between urban and rural groups. Analysis was performed both unadjusted and with adjustments for covariates. Subgroup analysis was performed for race and ethnicity, sex, and insurance type. Multiple imputation was performed to account for missing data in outcomes analysis.
Results:
Data from 1403 urban and 351 rural patients were analyzed. Urban infants had greater weight (-0.95 vs -1.16, P < .01) and height z scores (-1.65 vs -2.01, P < .01) at 1 year of age when compared with rural infants. When adjustments were made for covariates, there was no significant difference (weight P = .21, height P = .15). Odds of 1-year transplant free survival were lower in urban compared with rural infants (odds ratio for urban vs rural 0.72, P < .02).
Conclusions:
Rural infants with single-ventricle heart disease have greater transplant-free survival to their first birthday. Growth among rural infants may lag behind urban peers, but growth differences are attributable to demographic and disease severity factors.
