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Unplanned Readmissions in Pediatric Cardiac Disease: Impacts of Social Determinants of Health
Miriam T Fox1,2, Patrice Melvin3,4, Faraz Alizadeh5,6
1Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. Miriam.Fox@cardio.chboston.org.
Insights
Children with pediatric cardiac disease facing socioeconomic disadvantages experience higher unplanned readmission rates. Addressing social determinants of health is crucial for improving outcomes in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Social Determinants of Health
Background:
- Unplanned readmissions are a significant concern in pediatric cardiac disease management.
- Social determinants of health (SDOH) are increasingly recognized as critical factors influencing health outcomes.
- Understanding the interplay between SDOH and readmissions in pediatric cardiac patients is essential for targeted interventions.
Purpose of the Study:
- To investigate the association between social determinants of health and unplanned readmissions in pediatric cardiac disease.
- To identify specific SDOH factors contributing to higher readmission rates in this population.
- To explore variations in these relationships across different cardiac sub-cohorts (surgical vs. medical).
Main Methods:
- Retrospective cohort study utilizing data from the Pediatric Health Information System (January 2019 - March 2023).
- Inclusion of pediatric patients (<18 years) with cardiac admissions.
- Analysis of social determinants including Child Opportunity Index, insurance status, urbanicity, race, and ethnicity, assessing 90- and 365-day all-cause and cardiac-related readmissions.
Main Results:
- Higher all-cause readmission rates (90- and 365-day) were observed in children with Hispanic/Latino ethnicity, Black/African American race, Medicaid insurance, and low Child Opportunity Index scores.
- Adjusted analyses revealed increased odds of readmission associated with Hispanic/Latino ethnicity, Medicaid, urban residence, Multiracial background, and low opportunity areas.
- Findings were primarily driven by cardiac medical patients, with less pronounced effects in surgical readmissions. The Child Opportunity Index modified race-readmission relationships.
Conclusions:
- Children with cardiac disease experiencing socioeconomic disadvantages, public insurance, and belonging to underrepresented racial/ethnic groups have higher unplanned readmission rates.
- The Child Opportunity Index plays a significant role in modifying the relationship between race and readmission risk.
- Opportunities exist to optimize discharge planning, follow-up care, and preventative strategies to mitigate readmissions in this population.
Abstract:
To investigate relationships between unplanned readmissions and social determinants of health in pediatric cardiac disease. Retrospective cohort study of pediatric (< 18 years) cardiac admissions in the Pediatric Health Information System (1/2019-3/2023). Social determinants included Child Opportunity Index (lower opportunity indicates fewer neighborhood-level resources), insurance, urbanicity, race, and ethnicity. Primary outcomes were unplanned all-cause and cardiac-related 90- and 365-day readmissions. Sub-analyses were performed in cardiac surgical and cardiac medical (congenital versus acquired) cohorts. Of 320,225 admissions, 90- and 365-day all-cause readmission rates were 22.0%, and 33.6% (cardiac-related: 13.8% and 20.9%). Cardiac-surgical patients accounted for 9.4% of readmissions. All-cause 90- and 365-day readmissions were higher among children with Hispanic/Latino ethnicity, Black/African American race, Medicaid, and low/very low opportunity (p < 0.001). Adjusted odds of 90-day readmissions were greater for children with Hispanic/Latino ethnicity (aOR 1.04[95%CI 1.01-1.07]), Medicaid insurance (aOR 1.17[1.14-1.19]), and urban residence (aOR 1.11[1.08-1.14]). At 365 days, odds were also higher for children with Multiracial backgrounds (aOR 1.07[1.01-1.14]) and residing in low/very low opportunity areas (aOR 1.08[1.03-1.12]). All-cause readmission findings were primarily driven by cardiac medical patients with less pronounced effects in surgical readmissions. All-cause readmission rates decreased as opportunity increased for children with Asian and White race but not other racial/ethnic backgrounds. Cardiac-related readmissions had similar results, except for lower readmissions in children with Black/African American race. Children with cardiac disease with fewer resources, public insurance, and underrepresented racial/ethnic backgrounds have more unplanned readmissions. The child opportunity index modified race-readmission relationships. Opportunities exist to optimize discharge planning, follow-up, and preventative care.
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