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Child Opportunity, Race, and Language in Congenital Cardiac Surgery Outcomes

Kenneth M Coca1, Jamie L Fierstein2,3, Joseph Manipadam3

  • 1Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, 501 6th Avenue South Saint Petersburg, St. Petersburg, FL, 33701, USA. kenneth.coca@jhu.edu.

Pediatric Cardiology
|January 22, 2026
PubMed

Insights

Neighborhood opportunity did not impact surgical outcomes for children with congenital heart disease. However, racial and ethnic disparities and language barriers were linked to worse outcomes, indicating these factors may not be fully captured by neighborhood opportunity metrics.

Area of Science:

  • Pediatric Cardiac Surgery
  • Health Equity
  • Social Determinants of Health

Background:

  • Racial, ethnic, and language disparities intersect with socioeconomic factors, influencing children's opportunities.
  • These inequities may impact health outcomes, particularly for vulnerable populations like children undergoing complex medical procedures.

Purpose of the Study:

  • To evaluate the association between surgical outcomes and a composite child neighborhood opportunity index (COI), race/ethnicity, and language barriers in pediatric congenital heart surgery.
  • To determine if neighborhood opportunity fully explains observed disparities in surgical outcomes.

Main Methods:

  • Retrospective cohort study of 1,568 pediatric patients undergoing congenital cardiac surgery (2010-2023).
  • Patients categorized by quintiles of a composite neighborhood opportunity index (COI) based on address.
  • Outcomes analyzed: in-hospital mortality, length of stay (LOS), major complications. Adjusted analyses performed using generalized linear mixed models.

Main Results:

  • Neighborhood opportunity index (COI) was not independently associated with mortality, LOS, or complications.
  • Non-Hispanic Black patients had higher odds of in-hospital mortality and longer LOS compared to non-Hispanic White patients.
  • Patients with non-English-speaking caregivers experienced longer LOS.

Conclusions:

  • Composite neighborhood opportunity index (COI) did not independently predict surgical outcomes in pediatric congenital heart surgery.
  • Significant disparities in mortality and length of stay persisted based on race/ethnicity and caregiver language.
  • These findings suggest that COI may not fully encompass the impact of structural racism or communication barriers on pediatric cardiac surgical outcomes.

Keywords:
Child opportunity indexCongenital heart diseaseHealth disparitiesLanguage barriersRace and ethnicity

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