Evaluating Racial Disparities in Access to Common Pediatric/Congenital Transcatheter Interventions

Abstract

Background

Disparities in outcomes for congenital heart surgery patients have been observed. To our knowledge, these disparities have not been studied in pediatric/congenital interventional cardiology.

Objectives

The purpose of this study was to determine whether Black race or Hispanic ethnicity is associated with disparities in diagnosis, referral, and/or access to catheterization.

Methods

A multicenter cohort study of patients ≤18 years who underwent: 1) device closure of atrial septal defect (ASD); 2) device closure of patent ductus arteriosus; 3) balloon pulmonary valvuloplasty (BPV); and 4) balloon aortic valvuloplasty (BAV) at centers contributing to the IMPACT registry 6/1/2016-12/31/2022. The associations between race-ethnicity and age at procedure and other procedure-specific markers of disease severity were evaluated. Also, the associations between race-ethnicity and the risk of adverse events and the proportion of patients treated at high-, medium-, and low-volume centers for each procedure were evaluated.

Results

In total, 20,632 subjects were studied (34% ASD, 48% patent ductus arteriosus, 14% BPV, and 5% BAV). Race-ethnicity was associated with older age for ASD and BPV (P < 0.05) and more severe disease for BPV and BAV (P < 0.05). The proportion of Black and Hispanic patients was higher in low-volume than in high-volume centers (P < 0.05 for all procedures).

Conclusions

Minority race-ethnicity was associated with older age at referral and more severe disease, implying disparities in referral and/or access and higher likelihood of treatment at low-volume centers. Efforts to understand and mitigate disparities in this population should focus on screening, diagnosis, and access.