Regional racial and ethnic differences in mortality for congenital heart surgery in children may reflect unequal access to care

Pediatr Cardiol. Mar-Apr 2003;24(2):103-8. doi: 10.1007/s00246-002-0244-y. Epub 2002 Sep 25.

Abstract

The objective of this study was to explore racial differences in mortality for congenital heart surgery. We performed a population-based retrospective cohort study using hospital discharge abstract data from four states in 1996. The outcome measure was risk-adjusted in-hospital mortality. Cases of pediatric congenital heart surgery were classified into six risk categories using the Risk Adjustment in Congenital Heart Surgery method. Differences in risk-adjusted in-hospital mortality among racial groups were explored. Analyses stratified by state were used to identify regional differences. Of 5791 cases, 4822 (83%) were assigned to a risk group for analysis. Surgical mortality differed for whites compared to non-whites (3.7 vs 5.1%, p = 0.02). Among non-white groups, unadjusted mortality rates varied: Asian, 5.3%; black, 4.1%; Hispanic 4.9%; other, 7.3%; and missing, 7.6% (p = 0.008). Adjusted mortality also differed by race but was inconsistent across regions, making explanatory factors based solely on biology implausible. For example, compared to whites, blacks had a higher risk of dying in Massachusetts [odds ratio (OR) = 6.39, p = 0.08] but lower in Pennsylvania (OR = 0.41, p = 0.009). Adding insurance type to models did not eliminate racial differences. In risk-adjusted analyses, non-white groups had a higher risk of dying after congenital heart surgery than whites. Inconsistent effects among regions suggest that differential mortality is due to unequal access to care rather than biology.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cardiac Surgical Procedures / economics
  • Cardiac Surgical Procedures / methods
  • Cardiac Surgical Procedures / mortality*
  • Cause of Death*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Continental Population Groups*
  • Ethnic Groups / classification
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Health Services Accessibility*
  • Heart Defects, Congenital / ethnology
  • Heart Defects, Congenital / mortality*
  • Heart Defects, Congenital / surgery*
  • Hospital Mortality / trends*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Socioeconomic Factors
  • United States