Research Assessment #6

Topic: Pediatric Cardiology

Date: October 26, 2018
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Analysis:

The article was from a medical news website and it was an overview of a
study headed by Dr. Shabnam Peyvandi, a pediatric cardiologist at the University of
California, San Francisco Benioff Children’s Hospital, titled, “Socioeconomic
Mediators of Racial and Ethnic Disparities in Congenital Heart Disease Outcomes: A
Population‐Based Study in California”. The study essentially analyzed the role that
socioeconomic factors played in outcomes in neonatal children of different races
and ethnicities diagnosed with critical congenital heart diseases (CCHD), focusing
specifically on the difference in outcomes between Hispanic infants and non-
Hispanic white infants (due to the lack of representation of other races in the study
data).
Through analysis of medical files from California’s Office of Statewide Health
Planning and Development database, it was statistically proven that Hispanic infants
in California that were diagnosed with CCHDs, either hypoplastic left heart syndrome
or d- transposition of the great arteries, had a significantly greater chance of poor
outcomes when compared with non-Hispanic white infants. Dr. Peyvandi concluded
post-study that the two factors that seemed to have the most significant impact
included maternal education, whether it was prolonged for a period beyond 12
years at the least, and the presence of a private insurance.
This article greatly intrigued me as often we hear about the lack of access to
medical services in third-world countries but rarely do we hear about the domestic
lack of access in a first-world country. This led me to research into our health care and
it was eye- opening to see that United States is practically the only developed first-
world country to not provide universal healthcare, which restricts the level of
healthcare that some in the population can receive, due to economic status, and this
echoes the results of the study conducted by Dr. Peyvandi.
Overall, I learned a lot about the how socioeconomic factors play a huge role in
access to medical care facilities and how lack of access to these necessary resources,
especially in the case of these children diagnosed with critical congenital heart
disease, is a significant factor when comparing rates of death (among other poor
outcomes) between patients of different races and ethnicities.

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MLA Citation:

Dobkowski, Darlene. “Socioeconomic Factors Confer Poor Outcomes for Hispanic

Infants with Congenital Heart Disease.” Healio, 10 Oct. 2018,
www.healio.com/cardiology/pediatric-cardiology/news/online/{b932d164-c21e-
4a80-9f35-3ecabf5e4076}/socioeconomic-factors-confer-poor-outcomes-for-
hispanic-infants-with-congenital-heart-disease.

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(see next page for annotations)

Article Annotations:

Socioeconomic factors confer poor outcomes for Hispanic

infants with congenital heart disease
The association between Hispanic ethnicity and poor outcomes in neonatal
children with critical congenital heart disease(1) may be primarily explained
through socioeconomic factors(2), according to a study published in the Journal
of the American Heart Association.

“This study demonstrates the socioeconomic factors that can in part explain the
disparities seen between Hispanic infants with congenital heart disease compared
to white infants,” Shabnam Peyvandi, MD, assistant professor in the division of
pediatric cardiology at University of California, San Francisco, said in a press
release. “Maternal education levels(3) likely act as a proxy for other
socioeconomic factors that may impede access to care and
available resources to certain communities. Community engagement and
outreach to at-risk communities(4) are initial steps in identifying specific barriers
to health care access with a goal of improving outcomes for all children with
congenital heart disease.”

Researchers analyzed data from 1,796 infants(5) from California’s Office of

Statewide Health Planning and Development database with a gestational age
between 22 and 42 weeks who had hypoplastic left heart syndrome (n = 964) or
d-transposition of the great arteries(6) (n = 832). Information from this database
included infant and maternal clinical and demographic characteristics from
hospital discharge records. Other factors assessed were race/ethnicity,
socioeconomic factors, education, community dwelling and insurance status (7).

The primary outcome for infants with hypoplastic left heart syndrome was
death or more than three readmissions within the first year of life. For
infants with d-transposition of the great arteries, the primary outcome was
death(8) or more than one readmission within the first year of life.

Because other racial and ethnic groups such as non-Hispanic black and Asian
infants were less well-represented in the database, the analysis only
included infants who were Hispanic (n = 838) or non-Hispanic white(9) (n =
477), the researchers wrote.

Hispanic infants were more likely to have a poor outcome(10) compared with
non- Hispanic white infants (crude OR = 1.72; 95% CI, 1.37-2.17). Those who
were less likely to have poor outcomes included infants born to mothers with
an education greater than 12 years (crude OR = 0.5; 95% CI, 0.38-0.65) and
with private insurance(11) (crude OR = 0.65; 95% CI, 0.45-0.71).
Insurance status accounted for 27.6% of the link between Hispanic ethnicity
and outcome (95% CI, 6.5-63.1), whereas maternal education explained
33.2%(12) of the relationship (95% CI, 7-66.4), according to the researchers.
Mediators that were not significant in the relationship between Hispanic
ethnicity and outcome were birth weight (1.5%; 95% CI, –2.5 to 5.7) and
maternal age(13) (1.9%; 95% CI, –0.8 to 6.2).

“Providing additional resources to these vulnerable populations has the

potential to improve both short- and long-term outcomes(14), in addition to
being cost-effective (ie, decreasing the number [of] total hospital
admissions(15)),” Peyvandi and colleagues wrote. “Further work is being
performed to assess cost-effectiveness and to incorporate other measures of
socioeconomic status.” – by Darlene Dobkowski

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(1) Hispanic ethnicity correlates to a negative outcome for neonatal critical congenital
heart disease (CCHD)
(2) social class and economic factors: education, insurance, employment, etc.
(3) Maternal education is the root where other socioeconomic factors stem from
(4) community outreach is necessary to find a solution
(5) 1,796 infants' health records from California were analyzed
(6) two different major examples of CCHD
(7) different things analyzed for study include race, socioeconomic factors, maternal
education, insurance, etc.
(8) both CCCHDs had fatal outcomes primarily or increased hospital attendance due to the
nature of CCHDs
(9) reasons for concentrating study within the 1,796 infants initially analyzed; only Hispanic
and non-Hispanic white (1,315))
(10) Hispanic infants had a greater chance of having a poor outcome compared with non-
Hispanic white infants
(11) more reasons for poor outcomes: low maternal education and private insurance
(12) insurance and maternal education were two major factors that explained relationship
between Hispanic ethnicity and outcome (accounted for 60.8% together)
(13) maternal age and birth weight did not seem to significantly contribute to the
relationship between Hispanic ethnicity and outcome
(14) aiding these populations with lower potential outcomes in cases with CCHDs improves
care long term as well as short term
(15) proving resources to these populations increases cost efficiency as less hospital
admissions are necessary