Journal of the American Heart Association · 2025
Socioeconomic Status, Race, and Ethnicity in Management of Pediatric Supraventricular Tachycardia.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Javalkar Karina, Sleeper Lynn A, Newburger Jane, Dionne Audrey
Аннотация
BACKGROUND: An electrophysiology study (EPS) with ablation is often the preferred approach to management of supraventricular tachycardia (SVT) and/or preexcitation (Wolff-Parkinson-White syndrome) in children and adolescents. There are inequities in arrhythmia management in adults, but less is known in children. We aimed to determine whether socioeconomic inequities affect referral for EPS in children with SVT or Wolff-Parkinson-White syndrome.
METHODS: This retrospective observational study used the Pediatric Health Information System (49 children's hospitals' administrative data) from 2016 to 2022. We included children with SVT/Wolff-Parkinson-White syndrome at centers performing EPS and excluded those with congenital heart disease. The zip code-based Childhood Opportunity Index (COI; range 1-100) and race and ethnicity were predictors. Multivariable analysis included COI, age, race and ethnicity, census region, and preexcitation. The outcome was a procedure code for EPS.
RESULTS: Among 37 674 children with preexcitation (10 165) or SVT without preexcitation (27 509), 9840 (26.1%) underwent EPS. The median COI was 58 (interquartile range [IQR], 31-81). The sample was predominantly White non-Hispanic (58%), followed by Hispanic (16%) and Black non-Hispanic (12%). Children who underwent EPS had a higher COI than those who did not (median, 59 [IQR, 34-82] versus 57 [IQR, 30-81]; P<0.001). Black non-Hispanic patients had lower EPS rates than White non-Hispanic (P<0.001) and Asian (P<0.001) patients. Hispanic patients had lower EPS rates than White non-Hispanic (P=0.001) patients. In multivariable analysis, lower COI, race and ethnicity, region, and preexcitation predicted EPS.
CONCLUSIONS: In this multicenter study of pediatric patients, we found disparities in use of EPS for SVT/Wolff-Parkinson-White syndrome. In adjusted analysis, Black non-Hispanic and Hispanic children and those with a lower COI were less likely to undergo EPS.
METHODS: This retrospective observational study used the Pediatric Health Information System (49 children's hospitals' administrative data) from 2016 to 2022. We included children with SVT/Wolff-Parkinson-White syndrome at centers performing EPS and excluded those with congenital heart disease. The zip code-based Childhood Opportunity Index (COI; range 1-100) and race and ethnicity were predictors. Multivariable analysis included COI, age, race and ethnicity, census region, and preexcitation. The outcome was a procedure code for EPS.
RESULTS: Among 37 674 children with preexcitation (10 165) or SVT without preexcitation (27 509), 9840 (26.1%) underwent EPS. The median COI was 58 (interquartile range [IQR], 31-81). The sample was predominantly White non-Hispanic (58%), followed by Hispanic (16%) and Black non-Hispanic (12%). Children who underwent EPS had a higher COI than those who did not (median, 59 [IQR, 34-82] versus 57 [IQR, 30-81]; P<0.001). Black non-Hispanic patients had lower EPS rates than White non-Hispanic (P<0.001) and Asian (P<0.001) patients. Hispanic patients had lower EPS rates than White non-Hispanic (P=0.001) patients. In multivariable analysis, lower COI, race and ethnicity, region, and preexcitation predicted EPS.
CONCLUSIONS: In this multicenter study of pediatric patients, we found disparities in use of EPS for SVT/Wolff-Parkinson-White syndrome. In adjusted analysis, Black non-Hispanic and Hispanic children and those with a lower COI were less likely to undergo EPS.