Foster Care Status as an Understudied Social Driver of Health Outcomes for Children Needing Cardiac Surgery

Children and youth in foster care (CYFC) are known to have greater health care needs than children not in foster care; however, little is known about the outcomes among those with heart disease.

This single-center, retrospective study included patients (<18 years) who underwent cardiac surgery between 2017 and 2022. CYFC were identified using institutional medical records. Demographics, clinical characteristics, and outcomes were compared with non-CYFC. Generalized linear models assessed associations with long-term mortality, readmissions, and cumulative hospital days, adjusting for clinical factors and follow-up duration. Child Opportunity Index, payer, and race were separately added to models. This cohort was also identified in the Pediatric Health Information System to calculate International Classification of Diseases, Tenth Revision (ICD-10) code sensitivity and specificity.

Of 4431 patients post-cardiac surgery, 67 (1.5%) were CYFC. Compared with non-CYFC, CYFC had lower Child Opportunity Index scores (median 61 versus 72, P=0.016) and were more likely to be Black and have Medicaid coverage. When adjusting for clinical variables, CYFC had higher mortality (adjusted odds ratio, 2.7 [95% CI, 1.0-6.9]), readmissions (adjusted incidence rate ratio, 1.24 [95% CI, 1.04-1.48]), and total hospital days (adjusted exponentiated coefficient, 1.54 [95% CI, 1.13-2.15]). Including Child Opportunity Index scores, payer, and race variably affected associations with long-term outcomes. Only 16/67 (24%) CYFC were correctly coded in the Pediatric Health Information System, yielding sensitivity of 24% and specificity of 100%.

CYFC with heart disease have adverse long-term outcomes and greater hospital resource use. Improved capture of foster care status in administrative data is needed to guide future studies and reduce disparities.