The association of the child opportunity index on outcomes in paediatric patients with Wolff-Parkinson-White.

Abstract

Background: The Child Opportunity Index is an index of 29 indicators of social determinants of health linked to the United States of America Census. Disparities in the treatment of Wolff-Parkinson-White have not be reported. We hypothesise that lower Child Opportunity Index levels are associated with greater disease burden (antiarrhythmic use, ablation success, and Wolff-Parkinson-White recurrence) and ablation utilisation.

Methods: A retrospective, single-centre study was performed with Wolff-Parkinson-White patients who received care from January 2021 to July 2023. Following exclusion for <5 years old and with haemodynamically significant CHD, 267 patients were included (45% high, 30% moderate, and 25% low Child Opportunity Index). Multi-level logistic and log-linear regression was performed to assess the relationship between Child Opportunity Index levels and outcomes.

Results: Low patients were more likely to be Black (p < 0.0001) and to have public insurance (p = 0.0006), though, there were no significant differences in ablation utilisation (p = 0.44) or time from diagnosis to ablation (p = 0.37) between groups. There was an inverse relationship with emergency department use (p = 0.007). The low group had 2.8 times greater odds of having one or more emergency department visits compared to the high group (p = 0.004).

Conclusion: The Child Opportunity Index was not related with ablation utilisation, while there was an inverse relationship in emergency department use. These findings suggest that while social determinants of health, as measured by Child Opportunity Index, may influence emergency department utilisation, they do not appear to impact the overall management and procedural timing for Wolff-Parkinson-White treatment.