Neighborhood Child Opportunity Index and Outcomes in Pediatric Pulmonary Hypertension

The role of social determinants of health (SDoH) in pediatric pulmonary hypertension (PH) outcomes are inadequately characterized. We hypothesized outcomes differ according to SDoH with increased mortality in those from low Child Opportunity Index (COI) areas or non-local to our center, with public insurance, limited English proficiency and underrepresented races/ethnicities. In a single center, retrospective cohort study, pediatric PH patients with inpatient admission from 2015 to 2022 were identified using ICD-10 codes. Clinical therapies and outcomes were compared by SDoH controlling for clinical factors, admission count, and follow-up length. Of 1735 pediatric PH patients, 232 (13.4%) died. Median time to follow-up/death was 35 days (IQR 8, 241). Median age was 215 days (IQR 14, 1716) with PH groups of pulmonary arterial hypertension (22.9%), left heart disease (40.5%), lung disease (27.0%), thromboembolic (1.3%) and other (8.2%). Patients utilized ECMO (11.3%), lung transplant (1.5%), PDE5 inhibitors (31.7%), prostacyclins (3.1%), endothelin receptor antagonists (4.2%), and inhaled nitric oxide (34.9%). Therapy use did not differ by COI or race/ethnicity. Decedents had lower COI than survivors (median 61.5 vs. 69.0 p = 0.002). Mortality differed by insurance (15.5% public vs 11.7% private, p = 0.022) and race/ethnicity (highest [19.6%] in children with Black/African American race p < 0.001). 10-point COI increases had 7% lower adjusted mortality odds (95%CI 0.873, 0.987, p = 0.009). Children with Black/African American race had higher adjusted mortality odds (1.94 95%CI 1.2, 3.2 p = 0.012). In pediatric PH, lower COI and Black/African American race are independently associated with greater mortality. Findings highlight importance of studying SDoH in pediatric PH.