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Evaluating Racial Disparities in Access to Common Pediatric/Congenital Transcatheter Interventions
Michael L O'Byrne1, Kevin F Kennedy2, Ryan Callahan3
1Division of Cardiology The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Racial and ethnic minorities with congenital heart conditions face disparities, including delayed diagnosis and treatment at lower-volume centers. Addressing these inequities requires focused efforts on screening, diagnosis, and access to care.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Health Disparities Research
Background:
- Congenital heart surgery outcomes show observed disparities.
- Such disparities have not been previously studied in pediatric/congenital interventional cardiology.
- This study addresses this gap by examining race-ethnicity in interventional cardiology.
Purpose of the Study:
- To determine if Black race or Hispanic ethnicity is associated with disparities in diagnosis.
- To investigate disparities in referral patterns for interventional cardiology procedures.
- To assess disparities in access to cardiac catheterization for pediatric patients.
Main Methods:
- Multicenter cohort study of pediatric patients (≤18 years) undergoing device closure of atrial septal defect (ASD), patent ductus arteriosus, balloon pulmonary valvuloplasty (BPV), or balloon aortic valvuloplasty (BAV).
- Data collected from the IMPACT registry between June 1, 2016, and December 31, 2022.
- Evaluated associations between race-ethnicity, age at procedure, disease severity, risk of adverse events, and treatment center volume.
Main Results:
- 20,632 subjects were analyzed across ASD, patent ductus arteriosus, BPV, and BAV procedures.
- Race-ethnicity was linked to older age at procedure for ASD and BPV (P < 0.05).
- Minority race-ethnicity correlated with more severe disease for BPV and BAV (P < 0.05) and higher proportions treated at low-volume centers.
Conclusions:
- Minority race-ethnicity is associated with delayed referral and more severe congenital heart disease.
- These findings suggest significant disparities in referral and/or access to care.
- Future efforts should prioritize screening, diagnosis, and equitable access to mitigate these disparities.
Background:
Disparities in outcomes for congenital heart surgery patients have been observed. To our knowledge, these disparities have not been studied in pediatric/congenital interventional cardiology.
Objectives:
The purpose of this study was to determine whether Black race or Hispanic ethnicity is associated with disparities in diagnosis, referral, and/or access to catheterization.
Methods:
A multicenter cohort study of patients ≤18 years who underwent: 1) device closure of atrial septal defect (ASD); 2) device closure of patent ductus arteriosus; 3) balloon pulmonary valvuloplasty (BPV); and 4) balloon aortic valvuloplasty (BAV) at centers contributing to the IMPACT registry 6/1/2016-12/31/2022. The associations between race-ethnicity and age at procedure and other procedure-specific markers of disease severity were evaluated. Also, the associations between race-ethnicity and the risk of adverse events and the proportion of patients treated at high-, medium-, and low-volume centers for each procedure were evaluated.
Results:
In total, 20,632 subjects were studied (34% ASD, 48% patent ductus arteriosus, 14% BPV, and 5% BAV). Race-ethnicity was associated with older age for ASD and BPV (P < 0.05) and more severe disease for BPV and BAV (P < 0.05). The proportion of Black and Hispanic patients was higher in low-volume than in high-volume centers (P < 0.05 for all procedures).
Conclusions:
Minority race-ethnicity was associated with older age at referral and more severe disease, implying disparities in referral and/or access and higher likelihood of treatment at low-volume centers. Efforts to understand and mitigate disparities in this population should focus on screening, diagnosis, and access.
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