Social Drivers of Health, Management Bias, and Outcomes of Symptomatic Neonates With Tetralogy of Fallot.

BACKGROUND

Advances in tetralogy of Fallot care have improved outcomes; however, sociodemographic disparities among infants with symptomatic tetralogy of Fallot requiring neonatal intervention (sTOF) remain incompletely characterized.

OBJECTIVES

This study aimed to investigate sociodemographic and socioeconomic factors associated with management strategy and clinical outcomes in sTOF.

METHODS

We conducted a retrospective cohort study of neonates with sTOF undergoing intervention between January 2005 and November 2017 at 9 centers in the Congenital Cardiac Research Collaborative. The primary outcome was management strategy: primary complete repair vs staged repair. The primary predictor was the Childhood Opportunity Index, a neighborhood-level health composite measure. Secondary predictors included distance to cardiac center, maternal race-ethnicity, language, and insurance. Group differences were assessed using chi-square/Fisher tests with Holm adjustment, and multivariable models determined associations between predictors and outcomes.

RESULTS

Among 417 neonates, 180 (43%) underwent primary repair and 237 (57%) staged repair. Most were prenatally diagnosed (59%), non-Hispanic White (63%), and publicly insured (54%). In univariate analyses, Childhood Opportunity Index and maternal race-ethnicity were associated with management strategy; these associations attenuated after adjustment. Infants living >100 miles from a cardiac center had a higher hazard for mortality compared with those <50 miles (HR: 2.38; 95% CI: 1.07-5.30; P = 0.033). Maternal race-ethnicity and public insurance were associated with longer hospital stays and increased in-hospital complications.

CONCLUSIONS

Sociodemographic factors, including geography, race-ethnicity, insurance, and neighborhood opportunity, are associated with management and outcomes in neonates with sTOF. Distance to care, maternal race-ethnicity, and insurance have notable impacts on these outcomes and warrant further assessment to ensure equitable decision-making management strategies.