Peer-reviewed article
Child Opportunity, Race, and Language in Congenital Cardiac Surgery Outcomes.
Kenneth M Coca, Jamie L Fierstein, Joseph Manipadam, Vera Ignjatovic, Joyce Johnson et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether neighborhood opportunity (measured by a composite index) explains differences in surgical outcomes for children having heart surgery, and whether racial, ethnic, and language disparities exist. Among 1,568 children undergoing congenital cardiac surgery, neighborhood opportunity was not independently linked to mortality or complications after adjustment. However, Black children had higher rates of in-hospital death and longer hospital stays compared to White children, and children with non-English-speaking caregivers also had longer stays, suggesting that factors beyond neighborhood disadvantage drive health disparities.
Key points
- 57.4% of children lived in very low or low opportunity neighborhoods
- After adjustment, neighborhood opportunity index was not associated with mortality, length of stay, or complications
- Non-Hispanic Black patients had 2.19 times higher odds of in-hospital mortality compared to non-Hispanic White patients
- Non-Hispanic Black patients had significantly longer hospital stays (0.25 days longer, adjusted)
- Children with non-English-speaking primary caregivers had longer hospital stays (0.30 days longer, adjusted)
Limitations
This is a single-center retrospective study, so findings may not generalize to other hospitals or settings. The study cannot determine the mechanisms behind racial/ethnic disparities or explain why neighborhood opportunity did not mediate outcomes, leaving questions about underlying causes of the observed disparities unanswered.
Abstract
Racial and ethnic disparities and language barriers coexist with inequities in a child's educational, environmental, and economic opportunity. We evaluated the association between surgical outcomes and a composite child neighborhood opportunity index (COI), race and ethnicity, and language barriers among children undergoing congenital heart surgery. Utilizing the Society of Thoracic Surgeons database, we conducted a single-center retrospective cohort study of patients who underwent congenital cardiac surgery from 2010 to 2023. Patients were classified by quintile COI scores based on their reported address. Outcomes included in-hospital mortality, length of stay (LOS), and major complications. Adjusted analyses were performed using generalized linear mixed models. Among 1,568 patients, 51.2% were non-Hispanic White and 64.1% had public insurance. 57.4% lived in very low or low COI neighborhoods. Race, ethnicity, primary caregiver language, and insurance payer were significantly associated with COI (p < 0.0001). After adjustment, COI was not associated with mortality, LOS, or complications. Compared with non-Hispanic White patients, non-Hispanic Black patients had higher odds of in-hospital mortality (OR 2.19, 95% CI 1.07-5.30) and longer LOS (β = 0.25, 95% CI 0.09-0.42). Patients with non-English-speaking caregivers had longer LOS (β = 0.30, 95% CI 0.10-0.51). Neighborhood opportunity was not independently associated with surgical outcomes. However, disparities by race and ethnicity and language persisted, suggesting that COI may not fully capture structural racism or communication barriers in pediatric cardiac care.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Study examined whether neighborhood child opportunity index (COI) explains surgical outcome disparities; comparison of outcomes across race, ethnicity, and caregiver language groups
- Population
- 1,568 children undergoing congenital cardiac surgery at a single center (2010-2023); 51.2% non-Hispanic White, 64.1% with public insurance, 57.4% from very low or low opportunity neighborhoods
Key finding
Non-Hispanic Black patients had OR 2.19 (95% CI 1.07-5.30) for in-hospital mortality versus non-Hispanic White patients