Socioeconomic factors—namely a mother’s insurance status and level of education—weigh heavily on Hispanic infants’ chances of surviving critical congenital heart disease (CHD) in their first year of life, a study out of the University of California, San Francisco suggests.
Shabnam Peyvandi, MD, and colleagues’ work centered around two critical heart defects: hypoplastic left heart syndrome and d-transposition of the great arteries. Both conditions require neonatal surgery, and past work has suggested elements like race and ethnicity can play into the outcomes of those procedures.
“The cause of racial and ethnic disparity in CHD outcomes is largely unknown,” Peyvandi, an assistant professor at UCSF, and coauthors wrote in the Journal of the American Heart Association Oct. 10. “Race and ethnicity are mainly regarded as social constructs, thus healthcare disparities are likely mediated through various socioeconomic factors rather than through biological differences between groups.”
The team’s population-based cohort study drew from the California Office of Statewide Health Planning and Development database to track 1,315 white and Hispanic infants with CHD. Hispanic mothers tended to be younger, less educated and live in cities, and they often relied on public insurance and community hospitals for healthcare.
Peyvandi and her colleagues said Hispanic ethnicity on its own was associated with a 1.72-fold increased risk of one-year mortality, but infants whose moms were more educated and enrolled in private insurance saw more positive outcomes. Still, compared to the 70 percent of white women who had more than 12 years of schooling, just 22 percent of Hispanic mothers attended school that long. When it came to health insurance, 69 percent of white mothers had private coverage compared to 23.5 percent of Hispanic mothers.
“We found that even when excluding patients who died before hospital discharge, maternal education and insurance status continued to play a strong role in explaining the relationship between race/ethnicity and outcome,” Peyvandi et al. wrote. “In fact, the effect of these mediators seemed stronger in the sensitivity analysis. In particular, the total indirect effect was 9 percent higher when excluding patients who died before hospital discharge.”
The authors said their results can start to explain the poorer outcomes seen in Hispanic infants born in California, but their lack of consideration for other confounding factors like income, access to care and occupation limits the study. They’re working on a cost-effectiveness study right now that incorporates further measures of socioeconomic status.
“These findings begin to identify specific factors within racial and ethnic groups that can be targeted for intervention,” Peyvandi and colleagues said. “Providing additional resources to these vulnerable populations has the potential to improve both short- and long-term outcomes, in addition to being cost-effective.”