Anderson BR, Fieldston ES, Newburger JW, Bacha EA, Glied SA. Disparities in Outcomes and Resource Use After Hospitalization for Cardiac Surgery by Neighborhood Income. Pediatrics. 2018;141(3):e20172432.
Neighborhood characteristics (eg, poverty) are associated with disparities in many child health conditions, but have not been studied at the population level for children with congenital heart defects (CHD), the most common birth defect in the US. Using data from 46 children's hospitals for over 86,000 children <19 years old with CHD, children living in neighborhoods with the lowest median income had significantly higher in-hospital mortality after cardiac surgery (3.5%) than children in neighborhoods with the highest incomes (2.2%).
In this study from 2005-2015, median income at the neighborhood level was assigned by ZIP code of the child's home in 4 groups (quartiles). All analyses also took into account the hospital where surgery occurred, the year of surgery, the child's CHD condition and Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, as well as additional socioeconomic factors such as child's insurance status, race, ethnicity, and urban/rural location. Children in the lowest-income ZIP code quartile had 9% longer lengths of stay for their surgical hospitalizations than children in the highest-income neighborhood quartile. Accordingly, children in the poorest neighborhoods also had significantly higher median hospital costs ($58,077) than children in highest-income neighborhoods ($49,490) (p<.001). In a supplementary analysis of 1.17 million hospitalizations for all conditions (not just CHD) at the same hospitals from 2012-2015, there were similar findings of higher mortality, longer length of stay, and higher costs for children from the lowest-income neighborhoods compared with children from the highest-income neighborhoods. These findings highlight the importance of contextual factors at the community level that affect patients' health while patients are in the hospital - not just outside the walls.