title: Racial and ethnic disparities in post-operative mortality following congenital heart surgery.
abstract: OBJECTIVE
  This study assessed racial/ethnic disparities in post-operative mortality after surgery for congenital heart disease (CHD) and explored whether disparities persist after adjusting for access to care.
  
  
  METHODS
  We used the Pediatric Health Information System database to perform a retrospective cohort study of 44,017 patients with 49,833 CHD surgery encounters in 2004-2008 at 41 children's hospitals. We used χ(2) analysis to compare unadjusted mortality rates by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic) and constructed Poisson regression models to determine adjusted mortality risk ratios (RRs) and 95% CIs.
  
  
  RESULTS
  In-hospital post-operative mortality rate was 3.4%; non-Hispanic whites had the lowest mortality rate (2.8%), followed by non-Hispanic blacks (3.6%) and Hispanics (3.9%) (P < .0001). After adjusting for age, sex, genetic syndrome, and surgery risk category, the RR of death was 1.32 for non-Hispanic blacks (CI, 1.14-1.52) and 1.21 for Hispanics (CI, 1.07-1.37), both compared with non-Hispanic whites. After adjusting for access to care (insurance type and hospital of surgery), these estimates did not appreciably change (non-Hispanic blacks: RR, 1.27; CI, 1.09-1.47; Hispanics: RR, 1.22; CI, 1.05-1.41).
  
  
  CONCLUSIONS
  There are notable racial/ethnic disparities in post-operative mortality after CHD surgery that do not appear to be explained by differences in access to care.
authors.affiliation: Children's Healthcare of Atlanta, Division of Pediatric Cardiology, Emory University, Sibley Heart Center, Atlanta, GA 30322, USA. osterm@kidsheart.com
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Strickland
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000208:ethnology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D044469:Racial Groups; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology