Flora Nuñez Gallegos, Shiraz A Maskatia, Yun Zhang, Jeffrey D Zampi, George T Nicholson, Courtney McCracken, Christopher E Mascio, Christopher J Petit, Jennifer Romano, Dominic Zanaboni, Michael L O'Byrne, Alekhya Nanduri, Jeannette Wong-Siegel, Mark A Law, Courtney R Alvis, Shabana Shahanavaz, Sarosh P Batlivala, Sarah Speed, Jeffery J Meadows, Mariam Taleb, Athar M Qureshi, Hala Khan, R Allen Ligon, Rachel Weber, Bryan H Goldstein, Andrew C Glatz, Keila N Lopez
Sociodemographic factors, including geography, race-ethnicity, insurance, and neighborhood opportunity, are associated with management and outcomes in neonates with sTOF. Distance to care, maternal race-ethnicity, and insurance have notable impacts on these outcomes and warrant further assessment to ensure equitable decision-making management strategies.
BACKGROUND: Advances in tetralogy of Fallot care have improved outcomes; however, sociodemographic disparities among infants with symptomatic tetralogy of Fallot requiring neonatal intervention (sTOF) remain incompletely characterized.
OBJECTIVES: This study aimed to investigate sociodemographic and socioeconomic factors associated with management strategy and clinical outcomes in sTOF.
METHODS: We conducted a retrospective cohort study of neonates with sTOF undergoing intervention between January 2005 and November 2017 at 9 centers in the Congenital Cardiac Research Collaborative. The primary outcome was management strategy: primary complete repair vs staged repair. The primary predictor was the Childhood Opportunity Index, a neighborhood-level health composite measure. Secondary predictors included distance to cardiac center, maternal race-ethnicity, language, and insurance. Group differences were assessed using chi-square/Fisher tests with Holm adjustment, and multivariable models determined associations between predictors and outcomes.
RESULTS: Among 417 neonates, 180 (43%) underwent primary repair and 237 (57%) staged repair. Most were prenatally diagnosed (59%), non-Hispanic White (63%), and publicly insured (54%). In univariate analyses, Childhood Opportunity Index and maternal race-ethnicity were associated with management strategy; these associations attenuated after adjustment. Infants living >100 miles from a cardiac center had a higher hazard for mortality compared with those <50 miles (HR: 2.38; 95% CI: 1.07-5.30; P = 0.033). Maternal race-ethnicity and public insurance were associated with longer hospital stays and increased in-hospital complications.
CONCLUSIONS: Sociodemographic factors, including geography, race-ethnicity, insurance, and neighborhood opportunity, are associated with management and outcomes in neonates with sTOF. Distance to care, maternal race-ethnicity, and insurance have notable impacts on these outcomes and warrant further assessment to ensure equitable decision-making management strategies.