title: Lower socioeconomic status is associated with worse outcomes after both listing and transplanting children with heart failure.
abstract: The relationship between SES and outcomes surrounding pediatric cardiac transplantation is complex and influenced by recipient race. Broad-based studies of SES have not been performed. A retrospective review of all 5125 primary pediatric heart transplants performed in the United States between 2000 and 2011. Patients were stratified by SES based on zip code of residence and U.S. census data (low SES: 1637; mid-SES: 2253; high SES: 1235). Survival following listing and transplantation was compared across strata. Risk-adjusted long-term mortality on the waitlist was higher among low SES patients (hazard 1.32, CI 1.07-1.63). The relationship between SES and outcomes varied by race. Early risk-adjusted post-transplant outcomes were worst among high SES patients (10.8% vs. low SES: 8.9%, p < 0.05). The incidence of non-compliance was higher among low SES patients (p < 0.0001). Long-term risk-adjusted patient survival was poorer among low (hazard 1.41, CI 1.10-1.80) and mid-SES (1.29, 1.04-1.59) groups. Low SES is associated with worse outcomes on both the waitlist and late following transplantation. Higher SES patients had more complex transplants with higher early mortality. Further research should be directed at identifying and addressing underlying causal factors for these disparities.
authors.affiliation: Nemours, A.I. duPont Hospital for Children, Wilmington, DE 19806, USA. rdavies@nemours.org
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Davies
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.forename: Clifford
authors.initials: C
authors.lastname: Chin
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.forename: Hari R
authors.initials: HR
authors.lastname: Mallidi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011203:Poverty; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012923:Social Class; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists
keywords: children; heart transplant; social class