Impact of Neighborhood Socioeconomic Status on Outcomes Following First-Stage Palliation of Single Ventricle Heart Disease

Background The impact of neighborhood socioeconomic status (SES) on outcomes following first-stage palliation of single ventricle heart disease remains incompletely characterized. Methods and Results This was a single-center, retrospective review of consecutive patients who underwent the Norwood pro...

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Bibliographic Details
Published in:Journal of the American Heart Association 2023-03, Vol.12 (6), p.e026764
Main Authors: Sengupta, Aditya, Bucholz, Emily M, Gauvreau, Kimberlee, Newburger, Jane W, Schroeder, Margaret, Kaza, Aditya K, Del Nido, Pedro J, Nathan, Meena
Format: Article
Language:English
Subjects:
Aftercare
congenital
disparity
Humans
neonate
Norwood Procedures - adverse effects
Original Research
Patient Discharge
Retrospective Studies
Risk Factors
social
Social Class
surgery
Treatment Outcome
Univentricular Heart - surgery
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Summary:Background The impact of neighborhood socioeconomic status (SES) on outcomes following first-stage palliation of single ventricle heart disease remains incompletely characterized. Methods and Results This was a single-center, retrospective review of consecutive patients who underwent the Norwood procedure from January 1, 1997 to November 11, 2017. Outcomes of interest included in-hospital (early) mortality or transplant, postoperative hospital length-of-stay, inpatient cost, and postdischarge (late) mortality or transplant. The primary exposure was neighborhood SES, assessed using a composite score derived from 6 US census-block group measures related to wealth, income, education, and occupation. Associations between SES and outcomes were assessed using logistic regression, generalized linear, or Cox proportional hazards models, adjusting for baseline patient-related risk factors. Of 478 patients, there were 62 (13.0%) early deaths or transplants. Among 416 transplant-free survivors at hospital discharge, median postoperative hospital length-of-stay and cost were 24 (interquartile range, 15-43) days and $295 000 (interquartile range, $193 000-$563 000), respectively. There were 97 (23.3%) late deaths or transplants. On multivariable analysis, patients in the lowest SES tertile had greater risk of early mortality or transplant (odds ratio [OR], 4.3 [95% CI, 2.0-9.4;
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.122.026764