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The Impact of Race and Ethnicity on Congenital Diaphragmatic Hernia 1-Year Mortality
Stephanie M Tsoi1, Kayla L Karvonen2, Martina A Steurer1,2,3
1Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
Insights
Socioeconomic status (SES) significantly impacts congenital diaphragmatic hernia (CDH) infant mortality disparities, particularly for Hispanic mothers. For Black mothers, unmeasured racial factors contribute more to mortality differences in infants with CDH.
Area of Science:
- Medical research
- Public health
- Pediatric health
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect with significant infant mortality.
- Existing research indicates racial/ethnic disparities in CDH outcomes.
- The role of socioeconomic status (SES) and other factors in these disparities requires further investigation.
Purpose of the Study:
- To examine 1-year mortality disparities in infants with congenital diaphragmatic hernia (CDH) based on maternal race/ethnicity.
- To quantify the mediating effects of socioeconomic status (SES) and maternal/neonatal medical factors on these disparities.
Main Methods:
- Utilized the US Natality Database (2014-2019), linking birth and death records up to 1 year of age.
- Identified infants diagnosed with congenital diaphragmatic hernia (CDH).
- Employed structural equation modeling to assess mediation effects of SES (maternal education, public insurance) and clinical factors.
Main Results:
- 1-year mortality for infants with CDH was 28.4% among 2589 identified cases.
- Mortality rates varied by maternal race/ethnicity: Non-Hispanic White (25.5%), Black (39.1%), Hispanic (31.2%).
- Socioeconomic status (SES) explained 54.1% of the disparity between Non-Hispanic White and Hispanic mothers, but only 17.1% for Non-Hispanic White and Black mothers. Unmeasured racial effects accounted for 75.9% of the disparity in Black mothers.
Conclusions:
- Socioeconomic status (SES) is a major contributor to CDH mortality disparities for Hispanic mothers.
- For Black mothers, unmeasured racial factors, potentially including social determinants of health and systemic racism, play a larger role in CDH mortality disparities.
- Addressing these disparities requires a multifaceted approach considering SES, social determinants, and systemic biases.
Objectives:
To evaluate disparities in 1-year mortality in infants with congenital diaphragmatic hernia (CDH) by maternal race/ethnicity in a US population-based dataset, and to quantify mediation effects of socioeconomic status (SES) and maternal and neonatal medical factors.
Study Design:
We identified infants with CDH from the US Natality Database (2014-2019) that links birth and death certificates to 1-year of age. Primary outcome was 1-year mortality. Primary predictor was maternal race/ethnicity. Candidate mediators (SES [defined by maternal education level and public insurance status] and neonatal and maternal factors) were assessed using structural equation modeling.
Results:
Among 2589 infants with CDH, 1-year mortality was 28.4% (n = 734). Infant mortality differed by maternal race/ethnicity: Non-Hispanic White 25.5%, Black 39.1%, Hispanic 31.2%. Mortality differences persisted in multivariate analysis. Mediation analyses showed that SES accounted for 54.1% (20.4-68.6%) of the disparity between infants of Non-Hispanic White and Hispanic mothers. In contrast, SES accounted for only 17.1% (3.6-37.4%) of the disparity between infants of Non-Hispanic White and Black mothers, while the unmeasured remaining effect of race/ethnicity contributed 75.9% (49.5-91.1%).
Conclusions:
In CDH, SES accounts for a large proportion of the mortality disparity for infants of Hispanic mothers while the remaining effect of race, aside from SES and neonatal factors, accounts for a large proportion of the mortality disparity for infants of Black mothers. The remaining effect of maternal race may be due to unmeasured aspects of SES, such as social determinants of health, and structural and systemic racism and bias.
