The Impact of Race and Ethnicity on Congenital Diaphragmatic Hernia 1-Year Mortality.

Objectives: To evaluate disparities in 1-year mortality in infants with congenital diaphragmatic hernia (CDH) by maternal race/ethnicity in a US population-based dataset, and to quantify mediation effects of socioeconomic status (SES) and maternal and neonatal medical factors.

Study design: We identified infants with CDH from the US Natality Database (2014-2019) that links birth and death certificates to 1-year of age. Primary outcome was 1-year mortality. Primary predictor was maternal race/ethnicity. Candidate mediators (SES [defined by maternal education level and public insurance status] and neonatal and maternal factors) were assessed using structural equation modeling.

Results: Among 2589 infants with CDH, 1-year mortality was 28.4% (n = 734). Infant mortality differed by maternal race/ethnicity: Non-Hispanic White 25.5%, Black 39.1%, Hispanic 31.2%. Mortality differences persisted in multivariate analysis. Mediation analyses showed that SES accounted for 54.1% (20.4-68.6%) of the disparity between infants of Non-Hispanic White and Hispanic mothers. In contrast, SES accounted for only 17.1% (3.6-37.4%) of the disparity between infants of Non-Hispanic White and Black mothers, while the unmeasured remaining effect of race/ethnicity contributed 75.9% (49.5-91.1%).

Conclusions: In CDH, SES accounts for a large proportion of the mortality disparity for infants of Hispanic mothers while the remaining effect of race, aside from SES and neonatal factors, accounts for a large proportion of the mortality disparity for infants of Black mothers. The remaining effect of maternal race may be due to unmeasured aspects of SES, such as social determinants of health, and structural and systemic racism and bias.