Intersection of paediatric heart disease and foster care status: a multicentre retrospective cohort study

Children and youth in foster care (CYFC) face unique medical, social and economic challenges that contribute to health disparities. CYFC with heart disease represent a particularly high-risk population, yet their characteristics and outcomes are underexplored.

In this multicentre, retrospective cohort study of all cardiac surgical and non-surgical heart disease admissions among children <18 years between 2017 and 2022, CYFC were identified using the International Classification of Disease, Tenth Revision (ICD-10) code Z62.21 in the Pediatric Health Information System database. Demographics, clinical characteristics and outcomes of CYFC were compared with those of children not in foster care (non-CYFC). Multivariable models assessed associations between foster care status and length of stay (LOS), in-hospital mortality and 30-day readmissions, adjusting for a fixed set of clinical variables. Childhood Opportunity Index, race and region were added separately to assess the influence of social determinants of health.

Of 95 113 total cardiac surgical and non-surgical admissions, 627 (0.7%) were identified as CYFC. CYFC were significantly more likely to have ≥2 complex chronic conditions, be Black and non-Hispanic, have public insurance, reside in rural locations and have lower Childhood Opportunity Index scores. After adjustment for clinical variables, LOS was 22% longer (95% CI 8% to 36%, p=0.001) for CYFC. There were no significant differences in in-hospital mortality or 30-day readmissions. These findings were unchanged after incorporation of Childhood Opportunity Index, race and region.

CYFC with heart disease experience greater medical complexity and have significantly longer hospital stays than their peers, despite similar in-hospital mortality and 30-day readmission rates. These findings highlight foster care status as an important and often under-recognised social determinant of health in paediatric cardiology and provide a foundation for future work to better understand and address factors influencing outcomes in this population.