Impact of Neighborhood and Individual Social Drivers of Health on Outcomes Following Congenital Heart Surgery.

Abstract

BackgroundDespite advances in congenital heart surgery (CHS) and improvements in outcomes, disparities continue to exist. Social Drivers of Health (SDoH) have been associated with many aspects of health and wellness including congenital heart disease. The goal was to evaluate the impact of individual and neighborhood-level SDoH on outcomes following CHS.MethodsRetrospective review of the Society of Thoracic Surgeons Congenital Heart Surgery Database from 2014 to 2022 linked via ZIP code with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). ZIP codes were ranked by their SVI score with the first quintile the least vulnerable and the fifth the most vulnerable. The primary outcome was STS perioperative mortality.ResultsA total of 49 centers with ≥85% ZIP code completion rate were included. Those with missing ZIP codes (n = 1329) or missing data (n = 5651) were excluded resulting in a final cohort of 16,238 (69.5%, 11,285/16,238) cases. Of the final cohort, 8,977/16,238 (55.3%) were Non-Hispanic White and 7084/16,238 (43.6%) had private insurance. There were 448/16,238 (2.8%) STS perioperative mortalities. In the fully adjusted model, individual Non-Hispanic Black race (OR:1.76 [95% CI: 1.20-2.52]), Non-Hispanic Other race (OR: 2.39 [95% CI: 1.10-4.99]), Medicaid (OR:1.55 [95% CI: 1.04-2.30]), None/Self/Charity Insurance (OR:2.60 [95% CI: 1.09-5.93]), as well as increasing SVI quintile with SVI2 (OR: 1.22 [95% CI: 0.86-1.75]), SVI3 (OR: 1.71 [95% CI: 1.07-2.73]), SVI4 (OR: 1.92 [95% CI: 1.04-3.53]) and SVI5 (OR: 3.09 [95% CI: 1.36-6.87]), had increased odds of STS perioperative mortality.ConclusionsAfter adjusting for clinical characteristics, both individual and neighborhood Social Drivers of Health conferred increased odds of perioperative mortality following CHS. These results spotlight the disparities driven by individual circumstances beyond clinical characteristics and reinforce the need to intervene at both the individual and community levels to improve outcomes.