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Ethnicity and survival after paediatric cardiac surgery in the UK
Daniel G W Cave1,2, Khurram Mustafa2,3, Kirsten Cromie2
1Leeds Congenital Heart Unit, Leeds Teaching Hospitals NHS Trusthttps://ror.org/00v4dac24, UK.
Insights
Children from Black and South Asian ethnic groups face higher mortality risks after paediatric cardiac surgery compared to White children. These survival disparities, particularly evident post-discharge, have decreased but persist, with causes remaining unclear.
Area of Science:
- Paediatric Cardiology
- Health Equity
- Surgical Outcomes
Background:
- Ethnicity is a known social determinant of health, influencing healthcare access and outcomes.
- Paediatric cardiac surgery involves complex procedures with varying survival rates.
- Understanding ethnic disparities in survival is crucial for improving equitable care.
Purpose of the Study:
- To investigate the impact of ethnicity on survival rates in children undergoing cardiac surgery.
- To identify potential ethnic differences in outcomes following paediatric cardiac procedures.
- To analyze survival trends over time and their relationship with ethnicity.
Main Methods:
- Observational study in a UK tertiary paediatric cardiac surgical centre.
- Inclusion of 3,508 children (0-15 years) undergoing their first cardiac surgical procedure (2005-2021).
- Primary outcome: 5-year survival; secondary outcomes: 30-day, 1-year, and pre-discharge survival, adjusted for deprivation.
Main Results:
- Higher adjusted mortality observed in South Asian and Black children compared to White children.
- Survival differences emerged post-discharge, widening at 90 days, 1 year, and 5 years.
- Improved 1-year survival for South Asian children in recent years, nearing parity with White children.
Conclusions:
- Black and South Asian children experience increased mortality risk post-paediatric cardiac surgery, irrespective of pre-operative factors.
- A significant proportion of excess deaths occur after hospital discharge.
- While inequities have reduced, the underlying reasons for ethnic disparities in survival remain unexplained.
Objectives:
To assess the impact of ethnicity on survival following paediatric cardiac surgery.
Methods:
Observational study of a regional tertiary paediatric cardiac surgical centre in Yorkshire, UK. All children (age 0-15 years) undergoing their first cardiac surgical procedure from January 2005 to December 2021 inclusive. The primary outcome was 5-year survival. Secondary outcomes included 30-day, 1-year, and pre-discharge survival.
Results:
3,508 children (46% female) underwent their first cardiac surgical procedure during the study period. Within the study cohort 2,578 (73%) children were White, 634 (18%) were South Asian, 95 (3%) were Black and 201 (6%) were from other ethnic groups. South Asian children were more likely to have a functionally single-ventricle (10% vs. 7% White; relative risk 1.41, 95% confidence interval 1.15-1.69).Mortality after surgery, adjusted for deprivation, was higher for South Asian (hazard ratio 1.50, 1.12-2.01) and Black children (hazard ratio 1.69, 0.93-3.06), compared to White children. Survival differences were not present at discharge or 30 days post-procedure, but widened progressively at 90 days, 1 year and 5 years. This was not influenced by diagnosis or pre-operative risk factors. One-year survival improved for South Asian children across the study period and was similar to that of White children from 2017-2021 (94.7% (89.8-97.3%) vs. 96.8% (94.9-97.9%) White).
Conclusions:
Black and South Asian children have a greater risk of death following cardiac surgery compared to White children, independent of pre-operative risk. The majority of excess deaths occurred after hospital discharge. Although inequities have steadily reduced over the past two decades, the explanation for this effect remains unclear.
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